This is a randomized clinical trial to measure the effect of tidal volume (group 6 ml/kg vs 10 ml/kg) on diaphragm dysfunction on mechanically ventilated critical patient.

Patient was enrolled in the first day receiving mechanical ventilation in ICU. Patient was included to group A or group B. Group A patient will receive tidal volume of 6 ml/kg and group B patient will receive tidal volume of 10 ml/kg. The assignment was randomized. Followed for 3 days. After 24, 48, and 72 hours, patient blood will be collected to measure the interleukin value, and diaphragm dysfunction will be observed by the use of ultrasonography by expert doctor from radiology department. Data will be analyzed statistically if there is an effect of tidal volume difference on diaphragm dysfunction and interleukin-6 as marker of inflammation. The minimal sample of patient is 44 patients.

Inclusion Criteria:

• Minimum age 18 years old
• Critically ill patients

Exclusion Criteria:

• Patient with ARDS (PaO2/FiO2 <200)
• Pregnant woman
• Patient with history of cardiac or thorax surgery 14 days prior to admission
• Patient with severe peripheral musculoskeletal conditions
• Patient with prolonged in-hospital stay (>2 weeks) in the last 3 months

IPD will not be shared since it is belong to the hospital and patient did not consent it to be published.

Participants are blinded to which group they belong and they have given consent to that.

The person assigning patients to each group is the research assistant. The person setting the mechanical ventilator is the anesthesiology resident. The person assessing outcome with ultrasound is radiology department staff, who does not know which group the patient belong.

The person assessing outcome of interleukin is laboratory personnel, who does not know which group the patient belong.

The person collecting and freezing data into worksheet is the research assistant.

The person analyzing final data is the primary investigator.