Participants were recruited from the Intensive Care Unit. To achieve concealed allocation, each random Selleck Y27632 allocation was concealed in an opaque envelope until a patient’s eligibility to participate was confirmed. Outcomes were measured immediately after the intervention. Patients who were intubated and had received mechanical ventilation for at least 48 hr in the Intensive Care Unit and who were initiating spontaneous breaths were eligible

to participate. Exclusion criteria were: ventilator associated pneumonia, positive end-expiratory pressure greater than 10 cmH2O, haemodynamic instability (defined as mean arterial pressure less than 60 cmH2O), contraindications to an increase in the applied inspiratory pressure (eg, pneumothorax, undrained haemothorax, subcutaneous emphysema), osteoporosis, peak airway pressure

greater than 40 cmH2O, neurosurgery, and a relative who was unwilling to consent to the patient’s participation. All participants received usual medical and nursing care while in the Intensive Care Unit. This included position changes second hourly, aspiration of the airway as needed, chest wall vibrations with compression twice a day. Clinical data including gender, age, baseline Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, comorbidities, start and end dates of mechanical ventilation, presence or absence of ventilator-associated pneumonia, type of ventilator and mode of ventilation were recorded at baseline. After randomisation, all participants were positioned supine in bed with the bedhead elevated 30 deg. In selleck this position, their airway was aspirated once with a 12-gauge suction catheter with a vacuum pressure of 40 cmH2O. Two hours later, haemodynamic Metalloexopeptidase and pulmonary measures were recorded.

The participants’ artificial airway was then aspirated 3 times with an open suction system, for 12 sec, at intervals of 30 sec, with the same catheter and vacuum pressure. The aspirate was collected in a vial and stored for weighing. Haemodynamic and ventilator measures were recorded 1 min later. These were the baseline measures. Approximately six hours later, all participants were again positioned in supine with the bedhead elevated 30 deg and had their airway aspirated once, as described above. Two hours later, haemodynamic and pulmonary measures were recorded. Experimental group participants then received manual chest wall compression with vibrations for 5 min to each hemithorax by a physiotherapist. During the application of these manual techniques, the ventilator settings were altered so that inspiratory pressure support increased by 10 cmH2O above the existing level. Control group participants received the same regimen of compression with vibration of the chest wall, but without any change in their ventilator settings.