Dads Who Deliver

When it comes to parenting, some dads really go the extra mile! Take the male seahorse, for instance. In an interesting twist on traditional roles, the female seahorse actually deposits her eggs into a specialized pouch on the male. He then takes over, fertilizing and incubating them until they're ready to hatch. Talk about being hands-on, or rather, pouch-on!

This incredible feat of paternal dedication makes male seahorses some of the most committed fathers in the animal kingdom. While most dads are content with just changing a diaper or two, these guys literally carry the weight of their offspring, bringing new meaning to the term "expectant father." It's a truly unique biological marvel that proves nature always has a few surprises up its sleeve!

Welcome to the 122nd edition of ResusNation!

Does The ABG Matter For Intubation?

When a patient The patient is in respiratory distress, every second counts. Many often reach for an arterial blood gas (ABG) test, thinking it will provide crucial information to decide if a patient needs a breathing tube (intubation). But this common practice causes unnecessary pain and doesn't actually help in these critical moments. The decision for intubation is, and should remain, a clinical one based on the patient's overall condition, not just numbers on a lab report.

An ABG rarely, if ever, provides new information that changes the decision to intubate a patient in respiratory distress. Instead, clinical signs—like a patient being drowsy and unable to protect their airway, or being in severe hypoxemia despite other interventions—are the real indicators. Causing a patient in respiratory distress additional pain for an ABG, especially when it doesn't alter the management plan, is often counterproductive. When you have a patient in respiratory distress your resources and focus should shift to your clinical assessment rather than relying on a painful and often unhelpful test.

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We just launced the ResusX:Workshops series, four incredible hands on workshops that will help you take your ressucitation skills to the next level. Whether you attend these on their own, or part of ResusX, you will level up your skills. Choose from on of the following:

• Total Ariway Workshop
• DysRhythmia Day with Amal Mattu
• Resus:Ready Procedure Workshop
• The Vent Workshop

Full schedules are available below and spots are very limited, so don't wait until the last minute to register!

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Less Time on the Vent?

For patients in the Intensive Care Unit (ICU) who need help breathing, being on a mechanical ventilator is a critical part of their care. However, staying on a ventilator for too long can lead to complications like pneumonia and delirium. Finding the right balance of pain medication is crucial to help patients recover faster and avoid these issues. This new research examine whether a different type of pain medication, remifentanil, could offer benefits over the commonly used fentanyl. The main finding suggests that using remifentanil might actually help patients get off the ventilator sooner.

This study, combining data from multiple studies, indicates that remifentanil may indeed shorten the time patients spend on breathing machines and could also reduce the risk of delirium. While the evidence is still developing and more high-quality studies are needed to confirm these findings definitively, the potential impact on patient recovery is significant. It's important to remember that every patient is different, and the best approach depends on many factors, including their other health conditions. Future research will help doctors fine-tune how these medications are used to ensure the best possible outcomes for critically ill patients.

Here's my Takeaways:

• Finding: Remifentanil may reduce the duration of mechanical ventilation compared to fentanyl, with a potential reduction of 6.70 hours in randomized controlled trials and 21.26 hours in observational studies. It also may reduce the incidence of delirium.

• Practice Impact: Remifentanil could be considered as an opioid analgesic to potentially shorten mechanical ventilation duration and reduce delirium incidence in adult ICU patients.

• Population: The study specifically focused on adult patients receiving mechanical ventilation in the ICU. This included patients undergoing cardiac surgery, other types of surgery, and neurosurgery.

• Limitation: The certainty of the evidence is low due to significant heterogeneity across studies, and more high-quality randomized controlled trials are needed to confirm these benefits. Also, the clinical importance of a 90-minute reduction in ventilation duration is uncertain regarding its direct impact on major patient outcomes like mortality.

Want to learn more? Read the full study "Comparative efficacy of remifentanil and fentanyl in mechanically ventilated ICU patients: a systematic review and meta-analysis on ventilation duration and delirium incidence" by Hiromu Okano et al. in the Journal of Anesthesia, Analgesia and Critical Care.

Watch the June's Videos Now!

If you're an All-Access Member, you're in for some great content this month. We have FIVE videos hand-picked by our staff that are high-yield and our most highly watched. We're featuring

• Dennis Kim on Cricothyroidotomies & Emergency Airways
• Danya Khoujah on Status Epilepticus
• Rory Spiegel on The Hidden Vital Sign
• Mohamed Hagahmed on Intubating the RV Failure
• Terren Trott on Focusing the Pulse

Each month we bring you fresh new content from the best of the best in resuscitation. If you're an All-Access member, go watch these videos NOW! If you're not, then sign up here.

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Do you want even more resus content anytime you want? For less than a cup of coffee, you can get even more content from @CriticalCareNow. Digital teaching sessions, free video lectures, grand rounds, and so much more can be your today. Come watch on replay all the content that @CriticalCareNow does live. 

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