Short Effects of SIMT and EM in Prolonged Mechanically Ventilated Patients

Inclusion Criteria: * Patients with respiratory diseases who have been on mechanical ventilation for more than 48 hours and are ready to be weaned off or undergoing weaning trials with continuous positive airway pressure (CPAP) or synchronized intermittent mandatory ventilation (SIMV). * The PaO2/FiO2 ratio is ≥ 150-200, with FiO2 ≤ 0.4-0.5 and PEEP ≤ 5-8 cmH2O, and a pH \> 7.3 in blood plasma. * The age range is between 40 and 80 years old. * Patients exhibit good self-awareness and cooperation in training (Riker score of 4). * They can understand and communicate in Thai Exclusion Criteria: * Clinical instability (HR \> 120 beats/minute, RR \> 30 breaths/minute, SatO2 \< 90%, SBP \> 140 mmHg or \< 90 mmHg) * Patients who can be extubated and use non-invasive ventilation only or successfully extubated within the first 24 hours. * Patients with altered mental status (Glasgow Coma Score \< 10) and inability to cooperate with training (Riker score \< 4 or \> 4) * Patients with limitations or contraindications such as inability to adjust the bed to a 45-degree angle or sit on the side of the bed, such as those with spinal cord injuries or recent head surgeries. * History of hemoptysis, pneumothorax * History of neuromuscular diseases causing muscle weakness and decreased sensation. * Patients with excessive cardiac stimulation (\> 5 micrograms per kilogram per minute) * Heart rate \> 140 beats per minute * Hemoglobin levels \< 8-10 grams per deciliter * Patients with difficult airway issues.