combining techniques

Hi all,
just wanted to share an treatment session where i combined a number of techniques to produce an effective treatment. We had a patient with infective pneumonia (and on Xray- a very prominent right upper lobe consolidation). The patient was intubated at the time. We decided we would position the patient in high sitting (with the help of nurses and orderlies) to provide some postural drainage, and adjust the ventilator settings to hyperinflate (hence get some increases in collateral ventilation and shear secretions etc etc) At the same time as we hyperinflated, I also provided some rib springing at end of expiration to increase lung volumes and some expiratory vibrations focused on the right upper lung zone to loosen secretions. After a few cycles lasting a minute or so each, we suctioned very large amounts of sputum via his ETT, and on auscultation there was a significant decrease of the amount of coarse crackles which were heard prior to treatment. Overall, it was very useful combining all three techniques for treatment.