this study will be conducted to distinguish between effect of rib mobilization and routine chest physiotherapy on weaning parameters from mechanical ventilator in patients with pneumonia •

HYPOTHESES:

It will be hypothesized that there may be significant effect of rib mobilization on weaning parameters from mechanical ventilator in patients with pneumonia.

RESEARCH QUESTION:

Does rib mobilization have an effect on weaning parameters from mechanical ventilator in patients with pneumonia? measuring weaning parameters: on screen of mechanical ventilator : measuring respiratory rate, Tidal volume (TV), FiO2.

• Arterial blood gases (ABG) analyzer machine ABG is recorded daily (PH- PaO2 - PaCO2)
• Length of ICU stay: calculated by (admission date - discharge date
• Weaning success rate

Ventilator-associated pneumonia (VAP) represents a significant sub-set of (HAP) remains the most frequent intensive care unit (ICU)-acquired infection its incidence ranges from 9% to 27% of ventilated patients ,VAP is associated with an increased length of stay, mortality and health care costs, Pneumonia can result in chest wall stiffness, decreased mobility, limiting the range of motion during breathing and decreased lung compliance and impaired respiratory function , Rib mobilization: is an articular , non-invasive, passive technique that can be useful with acutely ill, hospitalized patients emphasizes the placement of a repetitive force to increase the range of motion of the posterior rib articulations and chest wall , lessening somatic dysfunction of the spine, stretches myofascial structures and improve respiratory mechanics So, this study will be conducted to distinguish between effect of rib mobilization and routine chest physiotherapy on weaning parameters among intubated pneumonic patients on mechanical vent.

Inclusion Criteria:

1. Patient's age ranged from 40- 50 years old from both genders.
2. Diagnosed with pneumonia and need invasive mechanical ventilation support.
3. Stable oxygen saturation (SpO2 more than 85, (FiO2) 0.6 or less, PEEP less than 10 Cm H2O).
4. mean arterial pressure > 75 mmHg and urine output > 1 mL/kg/h;
5. Patients with Glasgow coma scale (GCS) > 8T
6. Unconscious and semi-conscious patients. -

Exclusion Criteria:

1. Unstable hemodynamics
2. Unstable neurological problems e.g. (epileptic seizures -hyperthermia).
3. Unstable chest wall e.g. (multiple rib or vertebral fractures)
4. Increase intracranial pressure (>20 mmHg for >5 min).
5. Undrained pneumothorax, recent pulmonary surgery