Shane- I personally prefer MHI as I can get a good feel for what is happening in the lungs. I worked with ITU consultants who wanted us to use MHI more aggressively than has traditionally used. They taught me a recruitment manoeuvre which certainly worked to keep sats at an acceptable level following treatment for patients who were quite PEEP dependent. I am working academically now but I believe there is a move to more VHI. I would be interested to see any research comparing the two techniques.