The aim of hyperinflation in the ventilated intensive care unit patient is to increase oxygenation, reverse lung collapse and clear sputum. The efficacy and consistency of manual hyperventilation is well supported in the literature, but there is limited published evidence supporting hyperventilation utilising a ventilator. Despite this, a recent survey established that almost 40% of Australian tertiary intensive care units utilise ventilator hyperinflation. The aim of this non-inferiority cross-over study was to determine whether ventilator hyperinflation was as effective as manual hyperinflation in clearing sputum from patients receiving mechanical ventilation using a prescriptive ventilator hyperinflation protocol. A total of 46 patients received two randomly ordered physiotherapy treatments on the same day by the same physiotherapist. The efficacy of the hyperinflation modes was measured by sputum wet weight. Secondary measures included compliance, tidal volume, airway pressure and P a O 2 /FiO 2 ratio. There was no difference in wet weight of sputum cleared using ventilator hyperinflation or manual hyperinflation (mean 3.2 g, P=0.989). Further, no difference in compliance (P=0.823), tidal volume (P=0.219), heart rate (P=0.579), respiratory rate (P=0.929) or mean arterial pressure (P=0.593) was detected. A statistically significant difference was seen in mean airway pressure (P=0.002) between techniques. The effect of techniques on the P a O 2 /FiO 2 response ratio was dependent on time (interaction P=0.024). Physiotherapy using ventilator hyperinflation cleared a comparable amount of sputum and was as safe as manual hyperinflation. This research describes a ventilator hyperinflation protocol that will serve as a platform for continued discussion, research and development of its application in ventilated patients.
The knowledge economy requires an adept workforce and cadre of leaders to help address the many challenges and needs facing companies, governments and societies worldwide. Many of the challenges we face today are new and there will undoubtedly be others arise in the future that will require innovative approaches and solutions to overcome them. No longer are higher education institutions able to train graduates to address all of the current and emerging challenges from a singular disciplinary source. Interdisciplinary (ID) approaches to research and training are essential underpinnings to best meet the dynamic needs of today's higher education students. As the first in a series of forthcoming articles on ID research, this article examines ID trends in higher education research, instruction and degree offerings. It highlights how central ID solutions are in helping to address some of the most complex needs and challenges in higher education today, including how best to prepare higher education graduates for future employment and leadership positions.
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Higher education professional development trends increasingly focus on areas of quality improvement, quality assurance and optimal technology delivery models to achieve academic excellence. World-class universities rely on their faculty professional development centres for an array of professional development programmes to support teaching, research and student learning. This article examines faculty development centres at eight world-class universities in Australia, China, the United Kingdom and the United States: Australian National University, London School of Economics and Political Science, Carnegie Mellon University, University of Hong Kong, University of Melbourne, University of Oxford, University of Pennsylvania and University of Pittsburgh. Findings from this study include the structural characteristics of each centre as well as a summary of best practices in terms of programme development and resource management. We provide suggestions and recommendations to assist higher education administrators interested in establishing or strengthening professional development programmes at their own institutions.
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