Hi sdkashif,
I do not have an answer to your question, however I would like to make a comment based on my clinical experience.I am a physical therapist in the USA and for the past 15 years I have practiced exclusively in the ICU( medical, cardiothoracic and surgical adult ICUs).As you probably know, in the USA we have the respiratory therapists who are responsible for the ventilator management, oxygen/breathing treatments delivery,etc...In this case, my ultimate goal as a physical therapist in the ICU is to improve mobility and minimize loss of functional independence .
In the hospital I work, we do not provide any kind of manual chest physiotherapy or manual hyperinflation. Every stable, intubated and mechanically ventilated patient gets OOB to a chair at least once daily with the nursing staff.
Once the patients are able to minimally participate with therapy and are hemodynamically stable, I start mobilizing them immediately.I do a "mobilization test", that means, if they can sit on the edge of bed, stand with a walker/ assistance and take steps in place, they start walking within their abililty to tolerate activity.
If they do not pass the "test", I work aggressively to help them be able to bear weight and take steps.
As far as airway clearance, it is amazing the amount of secretions we suction during and after mobilization. As far as lung expansion, can you think of any better way to expand your lungs by sitting up, standing, moving?
I have been absolutely fascinated by the results of early mobilization and ambulation of mechanically ventilated patients;a great majority of my patients are able to walk > 100 feet when they are weaned of the ventilator.That goes specially for patients which the cause of weaning failure is weakness.
Thoughts?
Chris

Christiane Perme, PT CCS
Board Certified Cardiovascular and Pulmonary Clinical Specialist
Senior Physical Therapist
The Methodist Hospital
6565 Fannin, M1-024
Houston, TX 77030
(713) 441-2675
FAX: (713) 441-0143
[email protected]
[email protected]