Effect Of Manual Hyper inflation and Suctioning On Lung Compliance in Mechanically Ventilated Patients with Adult Respiratory Distress Syndrome-A Randomized Cross Over Trial

INTERVENTION: Intervention1: manual hyperinflation,suctioning: manual hyperinflation will be given using laerdal bag and 3 sets of 6breaths will be given and suctioning will be given after each set Control Intervention1: suctioning: patient will be positioned in left lateral position for 6‐8min and then suctioned thrice.position changed to right lateral and suctioned thrice CONDITION: mechanically ventilated patients with adult respiratory distress syndrome PRIMARY OUTCOME: lung compliance‐‐‐‐‐‐Timepoint: outcome measure will be taken immediately,30min,60min,90min,120min in supine SECONDARY OUTCOME: peak airway pressure ; exhaled tidal volume ; airway resistance ; plateau pressure ; heart rate ; blood pressure‐‐‐‐‐‐Timepoint: Outcome measures will be taken immediately, 30 min, 60min, 90min, 120min in supine INCLUSION CRITERIA: Diagnosed cases of ARDS Intubated and mechanically ventilated for 24 hours Age between 18‐65 years Mean arterial pressure more than 60mm Hg