Effect of Adding PNF to IMT on Weaning Off MV

Inclusion Criteria: * Adults of both sexes * patients older than 18 years * Conscious and cooperative * Hemodynamic stability without significant vasopressor support. * No continuous sedation. * Mechanically ventilated due to type 1 or type 2 respiratory failure (RF) for at least 24 hours. * Mechanically ventilated in assisted ventilation mode * Are able to participate in training actively, weanable as regard shallow breathing index. * presence of weaning criteria as defined in the European Consensus Conference in 2007, including sedation reduction, spontaneous breathing cycles, Partial pressure of oxygen (PaO2)/ fraction of inspired oxygen (FiO2) ≥ 150, absence of inotropes or vasopressors at high doses or increasing doses (\< 1 mg/h), oxy-hemoglobin saturation (SaO2) \> 90% with FiO2≤ 50%, positive end expiratory pressure (PEEP) ≤ 8 cmH2O, temperature between 36 and 39 °C. Exclusion Criteria: * Hemodynamic or respiratory instability * Condition that can compromise weaning, such as heart failure. * Condition that can prevent adequate performance of inspiratory muscle training, such as neuropathy or myopathy. * Thoracic or abdominal surgery precluding the use of PNF exercises * Rib fractures * Current pregnancy * Cardiac arrest with a guarded neurological prognosis * Deep coma