Want to know the best technique for pulmonary toilet on trach patients? Ambu bag>HME>MDI adaptor>flex tube>ballard, try this setup. Attach the Setup with 10-20 peep Q4 hours and you see your patients do better and return to the vent less. So don't use nebs or IPPB if bronchodilators are needed. This can stream line your care especially at an understaffed, for profit LTAC.