Rehabilitation Program for Weaning From Mechanical Ventilator

Statement of the problem: Are there any differences between comprehensive rehabilitation program consisted of (peripheral muscle training and functional training) combined with inspiratory muscle training and traditional chest physical therapy consisted of (percussion, mechanical vibration, positioning and modified postural drainage) combined with inspiratory muscle training on weaning from mechanical ventilation as a primary outcome, respiratory muscle strength, peripheral muscle strength and functional status in difficult and prolonged weaning from mechanical ventilation as secondary outcomes? Purpose of the study: The aim of the present study will be to compare between the effect of comprehensive rehabilitation program combined with inspiratory muscle training and traditional chest physical therapy combined with inspiratory muscle training on weaning from mechanical ventilation as a primary outcome, inspiratory muscle strength, peripheral muscle strength, functional status as secondary outcomes.

Inclusion Criteria: * The general surgery patients who fail one weaning attempt of spontaneous breathing trial * Conscious patients * Hemodynamically stable patients (lack of hypotension or a need for only low-dose pressors) * The patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scale 20 or less Exclusion Criteria: * patients with persistent altered sensorium * patients with major cardiac arrhythmia * patients with comorbid medical conditions (e.g., neurological diseases) or who are under any sedative or paralytic agents that would interfere with strength measurements and limb exercises * patients with history of underlying neuromuscular disease or acquired polyneuromyopathies * patients who are unable to perform physical training due to preexisting joint dysfunction * obese patients