Inclusion and exclusion criteria
cough, chronic neurological disorders, voice, Infection
DISEASE, INFECTION
Our study included subjects over 18 years old, under mechanical ventilation, who remained for more than 24 h on invasive ventilatory assistance and were able to start the process of weaning. Participants should be alert (defined by the ability to perform objective actions, such as opening the eyes in response to a voice or a RASS score of -1 to +1), have overcome the acute phase of their disease, have a cough reflex, and have no excessive tracheobronchial secretion. Infection should be under control, cardiovascular status stable (heart rate ≤120 beats/min, and systolic blood pressure between 90 to 160 mmHg, without or on a low-dose of vasopressor), hemoglobin ≥8 g/dL, arterial oxygen saturation >90% with an inspired fraction of oxygen (FIOExclusion criteria were tracheostomy, chronic neurological disorders, low level of alertness, severely reduced left ventricular ejection fraction, and positive serology for HIV.