Inclusion Criteria:  patient hospitalize in Intensive Care Unit or Pulmonary Unit, having airway clearance problem associated with mucus hypersecretion, peak expiratory flow (PEF) <280 l/min, medical indication for respiratory physical therapy.  Exclusion Criteria:  contraindication to use of MI-E device (ex. bronchospasm, immediate follow-up to surgery of airway system, chest or abdominal region, untreated pneumothorax, hemodynamic failure, etc.), refuse to participate, pregnant, breastfeeding, insufficient cognitive status.