In this episode of Hot Topics, Dr. Nicholas Morris interviews Claire Dahyot-Fizelier, M.D, Ph.D., a professor of anesthesia and intensive care at the University of Poitiers, to explore the groundbreaking PROPHY-VAP trial published in The Lancet Respiratory Medicine. This landmark study investigates the impact of single-dose ceftriaxone prophylaxis on ventilator-associated pneumonia (VAP) in acute brain injury patients. Dr. Dahyot-Fizelier discusses the rationale behind the study, key findings and the broader implications for ICU practices. Tune in to discover how this trial could reshape approaches to infection prevention and improve patient outcomes in neurocritical care.

Show notes:

https://doi.org/10.1016/S2213-2600(23)00471-X

Dahyot-Fizelier C, Lasocki S, Kerforne T, Perrigault PF, Geeraerts T, Asehnoune K, Cinotti R, Launey Y, Cottenceau V, Laffon M, Gaillard T, Boisson M, Aleyrat C, Frasca D, Mimoz O, on behalf of the PROPHY-VAP Study Group and the ATLANREA Study Group. Ceftriaxone to prevent early ventilator-associated pneumonia in patients with acute brain injury: a multicentre, randomised, double-blind, placebo-controlled, assessor-masked superiority trial. The Lancet Respiratory Medicine. 2024 May 1;12(5):375-85.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

In this episode of Hot Topics, Dr. Nicholas Morris interviews Dr. Giuseppe Citerio, professor of anesthesia and intensive care at Milano-Bicocca University, about the ORANGE study, which investigated the neurological pupil index (NPI) for prognosticating outcomes in patients with acute brain injury. The study, involving 13 centers in Europe and North America, found that repeat abnormal NPI values, including zero, were predictors of poor outcomes. The study collected data every four hours for seven days and used a sophisticated statistical model to account for longitudinal changes. Despite initial expectations, the study did not find a strong correlation between the NPI and ICP, suggesting NPI should not be used as a surrogate for ICP. Future research may focus on developing a standardized response to low NPI values.

Show Notes:

https://doi.org/10.1016/S1474-4422(23)00271-5

Oddo M, Taccone FS, Petrosino M, Badenes R, Blandino-Ortiz A, Bouzat P, Caricato A, Chesnut RM, Feyling AC, Ben-Hamouda N, Hemphill JC. The Neurological Pupil index for outcome prognostication in people with acute brain injury (ORANGE): a prospective, observational, multicentre cohort study. The Lancet Neurology. 2023 Oct 1;22(10):925-33.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

For the latest episode in our Hot Topics series, Dr Nicholas Morris, FCNS is joined by Dr Jennifer Frontera, FNCS to discuss the NCS Guidelines for Seizure Prophylaxis in Adults Hospitalized with Moderate-Severe Traumatic Brain Injury. 

Download the guidelines at https://link.springer.com/article/10.1007/s12028-023-01907-x. 

In this week's PERSPECTIVES episode, Dr Nicholas Morris is joined by Dr Daryl Gress, Professor of Neurological Sciences at the University of Nebraska to discuss Dr Gress' lessons learned while building a new neurocritical care unit and training program at UCSF.

Post-intensive care clinics following admission to the intensive care unit (ICU) have gained significant traction in recent years across the United States and internationally. This movement has been driven by increasing recognition of the long-term sequela related to the experience of an ICU admission. This week, Dr Lauren Koffman is joined by Dr Matthew Jaffa and Dr Julia Carlson to discuss the landscape of post-neuroICU clinics and the impetus for their development and continuation.

In May 2014 Elisabeth Beraquit fell through the faulty doors of an elevator into an empty shaft, landing 30 feet below on top of the elevator car. She suffered multiple traumatic brain injuries, including subarachnoid hemorrhage, intraventricular hemorrhage, and a diffuse axonal injury. 10 years on and Elisabeth is thriving, running her own business in Philadelphia and living her best life. In this week’s episode she and her sister, Sarah, join Dr Lauren Koffman to discuss Elisabeth's Story of Hope.

You can read Elisabeth’s story in Currents at https://currents.neurocriticalcare.org/Stories-of-Hope/Article/story-of-hope-elisabeth.

In this week's episode, Dr Nicholas Morris is joined by Dr. Karen Hirsch and Dr. Teresa May to discuss their paper “Critical Care Management of Patients After Cardiac Arrest: A Scientific Statement From the American Heart Association and Neurocritical Care Society”.  We discuss the difference between a scientific statement and a guideline, areas of uncertainty, and research priorities for the post-arrest patient.

You can read the paper at https://www.ahajournals.org/doi/10.1161/CIR.0000000000001163. 

This week's Hot Topic is Intravenous Levothyroxine for Unstable Brain-Dead Heart Donors and Dr Nicholas Morris is joined by Dr Raj Dhar from Washington University School of Medicine to discuss his latest New England Journal of Medicine manuscript (https://pubmed.ncbi.nlm.nih.gov/38048188/). 

In this week's Master Class, Dr Stephan Mayer and Dr Jon Rosenberg are joined by Dr Krishna Rajajee to discuss non-invasive intracranial pressure monitoring

In this week's episode, Dr Nick Morris is joined by Dr Jose Suarez to discuss the recently updated NCS subarachnoid hemorrhage guidelines. We compare them with the recently released American Heart Association subarachnoid hemorrhage guideline; and we discuss the purpose of guidelines in general and how guidelines map out priorities for research.

In this week's episode, Dr. Nicholas Morris talks to Dr. Michael Rodricks (Immediate Past Chair of the NCS FNCS Credentialing Committee) and Dr. Jason Makii (NCS FNCS Credentialing Committee Chair-Elect) about the Fellowship in Neurocritical Care Society Designation.  Listeners can learn what the FNCS designation means, how to apply, and how to maximize their chances of success.

Point-of-care ultrasound (POCUS) is increasingly recognized as an essential skill for critical care providers, intended to enhance clinical assessments to improve patient care. Beyond its adaptation for procedural guidance, bedside ultrasound assessments can provide critical diagnostic information in a timely manner to guide real-time decision making for the acutely ill patient. An accumulating body of evidence has shown that POCUS can improve clinical outcomes and lower medical costs.

Over the past decade, there has been widespread adaptation of bedside ultrasonography by various critical care specialties, with respective governing societies issuing guidelines and position statements encouraging the use of POCUS. However, the field of neurocritical care has yet to fully embrace this innovative field, and neurocritical care training programs vary in their efforts to provide accessible, well-structured educational programs for trainees. 

This week, Dr Lauren Koffman is joined by Dr Thanujaa Subrahmaniam and Dr Judy Ch'ang to discuss the use of POCUS in neurocritical care and the opportunities to extend its application across NCC programs. 

You can read Dr Ch'ang and Dr Subrahmaniam's Currents article on POCUS in NCC at https://currents.neurocriticalcare.org/Leading-Insights/Article/point-of-care-ultrasound-education-in-neurocritical-care-a-call-to-action. 

On September 2022, Cameron Kuklick fell from a motorized rental scooter while returning to his hotel after celebrating his brother’s wedding in Harrisonburg, Virginia. Cameron experienced a severe traumatic brain injury (TBI) at the age of 30. Cameron and his family hope that by sharing their story and experiences, they too can provide hope and healing for others. In this week’s episode, Cameron joins Dr. Lauren Koffman and Dea Mahanes, DNP, APRN, CCNS, HEC-C, FNCS, who was on Cameron's care team, to discuss his Story of Hope.

You can read Cameron's story in Currents at https://currents.neurocriticalcare.org/Stories-of-Hope/Article/unbroken-stride-camerons-story-of-hope-overcoming-brain-injury-to-cross-the-finish-line.

The views expressed on the NCS Podcast are solely those of the hosts and guests and do not necessarily reflect the opinions or official positions of the Neurocritical Care Society.

En este episodio especial en Español, el Dr. Luis Torres conversó con el Dr. Jose Javier Provencio acerca de los inicios de la campaña Curing Coma, sus metas iniciales, los retos que la campaña ha logrado superar y algunas colaboraciones internacionales con la campaña. Tambien hablamos acerca del Día Mundial del Coma y que pueden los participantes esperar este 22 de Marzo.

In this week's episode, Dr Nick Morris is joined by Dr Susanne Muehlschlegel, Dr Katja Wartenberg, and Dr Krishna Rajajee to discuss the NCS' Neuroprognostication Guidelines, including guidelines development, clinical prediction models, and the best language for family meetings.

Dr Nick Morris is joined by Dr Brian Edlow and Dr Claude Hemphill from the Curing Coma Campaign to discuss the scientific aims of the Campaign, the emerging paradigms for assessing disorders of consciousness, and the need for worldwide collaboration on curing coma. 

Visit https://www.curingcoma.org to learn more about World Coma Day and the Curing Coma Campaign. 

Dr Nick Morris is joined by Dr. Tobias Gauss from Grenoble Alpes University Hospital in France.  to discuss the recently published OXY-TC trial, a multisite randomized controlled trial of ICP + brain oxygenation monitoring vs. ICP monitoring alone in patients with severe traumatic brain injury.

In the lead up to this year's World Coma Day (March 22), and in the first of three special episodes, Dr Nick Morris hosts Dr DaiWai Olson to discuss the Curing Coma Campaign and World Coma Day through the perspective of the neurocritical care nurse.

Visit https://www.curingcoma.org to learn more about World Coma Day and the Curing Coma Campaign. 

In this week's Master Class Dr Stephan Mayer and Dr Jon Rosenberg are joined by Dick Morberg, inventor of the Moberg® CNS Monitor, to discuss the development of the mutlimodality monitoring platform and the value and impact of time sychronized multimodal data.

The pandemic has finally been declared ‘over,’ though COVID-19 continues to linger. The phenomenon of burnout has been well documented pre-pandemic, in many cases due to understaffing. This was exacerbated by the severe strain of COVID-19 placed on the healthcare system, with nurses leaving in droves post-pandemic. While nursing professional organizations and unions have long advocated for formalized standards around nurse staffing in a variety of care settings, there has traditionally been stiff opposition, particularly from hospitals, nursing homes, and certain healthcare associations. Dr Jordan Yakoby joins Dr Lauren Koffman to discuss nurse staffing - a public health crisis in the making. 

Read Dr Yakoby's Currents article at https://currents.neurocriticalcare.org/Leading-Insights/Article/nurse-staffing-a-public-health-crisis-in-the-making. 

Dr. Ko is the Vice-Chair for Diversity, Equity, and Inclusion in the Department of Neurology at UCSF.  In this podcast, Dr Ko joins Dr Nick Morris to discuss her work in DEI, anti-racism, and the antidote to burnout.

Hosted by Dr Stephan Mayer and Dr Jon Rosenberg, this week we discuss the management of traumatic brain injury with Lori Shutter, MD, FNCS, FCCM, Professor of Neurology at the University of Pittsburgh's School of Medicine. 

Leveraging pre-existing partnerships between NCS and colleagues at Aminu Kano Teaching Hospital in Kano, Nigeria, in October 2023 we hosted a 2-day live ENLS training event for healthcare workers from across sub-Saharan Africa. Dr Morgan Prust and Dr Ismail Hassan join Dr Lauren Koffman to discuss the applicability and limitations of ENLS in sub-Saharan Africa.

You can read the Currents article that accompanies this episode at https://currents.neurocriticalcare.org/NCS-News/Article/emergency-neurological-life-support-understanding-its-applicability-and-limitations-in-africa. 

In this week's episode of Perspectives, Dr Nicholas Morris is joined by NCS Past President, Dr Gretchen Brophy, Professor of Pharmacotherapy & Outcomes Sciences and Neurosurgery with Virginia Commonwealth University (VCU) School of Pharmacy, Medical College of Virginia Campus, in Richmond.

On this weeks’ episode of Perspectives, Dr. Daniel Hanley, professor of neurology, neurosurgery, and anesthesiology/critical care medicine at the Johns Hopkins University School of Medicine, discusses the early days of neurocritical care at Johns Hopkins, the importance of family-centered care, and recent advances in the care of patients with intracerebral hemorrhage.

The transition from alteplase (ALT) to tenecteplase (TNK) in the management of acute ischemic stroke (AIS) has been an exciting and thoroughly discussed topic within the neurocritical care community. Although debates on the clinical efficacy and safety of TNK for AIS have subsided somewhat in light of recently published data, what remains lacking is a clear “road map” for institutions on how to properly implement the transition in thrombolytics. Brian Gilbert, PharmD, and Katie Qualls, PharmD, join Dr Lauren Koffman to discuss the transition from ALT to TNK for AIS.

You can read Brian and Katie's February 2023 article in Currents at https://currents.neurocriticalcare.org/Leading-Insights/Article/transitioning-alteplase-to-tenecteplase-for-acute. 

In our final episode of 2023 our host Nick Morris is joined by Dr Matthew Fink, founding director of the Neurology-Neurosurgery Intensive Care Unit at New York Presbyterian Hospital.

Listen to the latest episode of NCS INSIGHTS series, this time on Meningitis Encephalitis.

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by ceribell.

Time is brain when it comes to seizures. Ceribell Point of Care EEG empowers the bedside team to detect or rule out seizure activity in minutes. To learn more, visit ceribell.com.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

Join us as we follow up with Sidney Landis, who was previously featured as a Currents “Story of Hope” to hear more about her journey in recovering from a cerebral venous sinus thrombosis. The Story of Hope was written by Dr Pravin George, who was part of her neurocritical care team, and adds his perspective to hear care and journey. Hosted by Dr Lauren Koffman.

You can read Dr George's article at https://currents.neurocriticalcare.org/Stories-of-Hope/Article/story-of-hope-sidneys-triumph-over-stroke.

Listen to the latest episode of NCS INSIGHTS series, this time on Pediatric Emergencies with Dr Agnes Kielian (Boston Children's Hospital) and Dr Nikki Miller Ferguson (Children's Hospital of Richmond @ VCU).

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by ceribell.

Time is brain when it comes to seizures. Ceribell Point of Care EEG empowers the bedside team to detect or rule out seizure activity in minutes. To learn more, visit ceribell.com.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

Today we welcome Dr Christopher Kellner, Assistant Professor of Neurosurgery at Mount Sinai Icahn School of Medicine and pioneer in the surgical management of ICH. We discuss the evolution of surgical ICH management, including minimally invasive surgery, and hear Dr Kellner’s thoughts on the future of the field. Hosted by Dr Stephan Mayer and Dr Jon Rosenberg. 

Listen to the latest episode of NCS INSIGHTS series, this time on Subarachnoid Hemorrhage (part 2 of 2).

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by ceribell.

Time is brain when it comes to seizures. Ceribell Point of Care EEG empowers the bedside team to detect or rule out seizure activity in minutes. To learn more, visit ceribell.com.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

Developed between the American Academy of Neurology, the American Academy of Pediatrics, the Child Neurology Society, and the Society of Critical Care Medicine, and endorsed by the Neurocritical Care Society, this new guideline provides recommendations on the evaluation of brain death/death by neurologic criteria for both children and adults. In this episode of HOT TOPICS, Dr Alex Reynolds is joined by two of the guideline's co-authors Dr Ariene Lewis and Dr Matthew Kirschen to introduce the purpose and recommendations of the Consensus Guideline.

Access the guideline at https://n.neurology.org/content/early/2023/09/13/WNL.0000000000207740.

Read the AAN's press release at https://www.aan.com/PressRoom/Home/PressRelease/5119.

Listen to the latest episode of NCS' INSIGHTS series on Subarachnoid Hemorrhage (part 1 of 2)

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by Biogen.

Science that transforms patient lives. Science that seeks to solve societal problems. Science that acts with purpose. Science that is inspired by the diversity and passion of our people. Discover where science meets humanity at Biogen.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

Electroencephalography (EEG) is an important and relatively inexpensive tool that allows intensivists to monitor cerebral activity of critically ill patients in real time. Seizure detection in patients with and without acute brain injury is the primary reason to obtain an EEG in the Intensive Care Unit (ICU); and in response to the increased demand for EEG, advances in quantitative EEG (qEEG) created an approach to review large amounts of data instantly. Today, rapid response EEG is now available to reduce the time to detect electrographic seizures in limited-resource settings. In this week's MasterClass, our hosts Dr Jon Rosenberg and Dr Stephan Mayer are joined by Dr Lawerence Hirsch, Co-Director of the Critical Care EEG Monitoring Program at Yale School of Medicine to discuss the evolution, value, and impact of brain monitoring with EEG in the critically ill. 

The efficacy of Nicardipine versus Clevidipine in treating neurocritical care patients is an ongoing debate which strongly divides opinion; and so in this week's episode, Dr Alex Reynolds is joined by Colleen Bond, PharmD, and Andy Webb, PharmD, who from a pharmacy standpoint help us to navigate the debate and further our understanding of the pros and cons of each agent.

Listen to the next episode of NCS' INSIGHTS series, this time on Analgesia and Sedation. 

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by ceribell.

Time is brain when it comes to seizures. Ceribell Point of Care EEG empowers the bedside team to detect or rule out seizure activity in minutes. To learn more, visit ceribell.com.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

In this week's episode, Dr Lauren Koffman is joined by Dr Clio Rubinos to discuss her recent article in Currents - The Tower of Babel: Translating the ICU-EEG Nomenclature in Spanish.

Listen to the latest episode of NCS' INSIGHTS series, this time on Neuromuscular Emergencies.

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by Biogen.

Science that transforms patient lives. Science that seeks to solve societal problems. Science that acts with purpose. Science that is inspired by the diversity and passion of our people. Discover where science meets humanity at Biogen.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

Dr. Tommy T. Thomas is a Neurointensivist and Associate Professor at Emory University and member of NCS’ Inclusion in Neurocritical Care Committee. We hear how he became the first man on the Woman in Neurocritical Care Committee as we discuss representation, advocacy, and allyship in neurocritical care.

Listen to the sixth episode of NCS' INSIGHTS series, this time on Increased Intracranial Pressure.

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by Biogen.

Science that transforms patient lives. Science that seeks to solve societal problems. Science that acts with purpose. Science that is inspired by the diversity and passion of our people. Discover where science meets humanity at Biogen.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

The ENRICH trial compared the outcomes between early surgical intervention using the BrainPath® Approach (i.e., MIPS) and a medically managed cohort. The integrated surgical approach included a combination of available technologies, including the FDA-cleared NICO BrainPath® for non-disruptive access and NICO Myriad® to achieve the goal of maximum clot evacuation. Alex Reynolds is joined by the ENRICH trial PIs, Gustavo Pradilla, Jonathan Ratcliff, and Alex Hall plus guests Chris Kellner and Kara Melmed to discuss the findings of the ENRICH clinical trial.  

Mary Guanci is a fellow of the NCS and served as the Mass General Neuro ICU's first Clinical Nurse Specialist, with nearly four decades of experience in neurocritical care nursing. Tune in to hear her perspective on interprofessional education, burnout, and more!

Listen to the fifth episode of NCS' INSIGHTS series, this time on Intracerebral Hemorrhage.

The INSIGHTS series is hosted by Casey Albin, MD and Salia Farrokh, PharmD, and covers different topics from Neurocritical Care ON CALL®, the only up-to-date, comprehensive resource to offer content exclusively dedicated to the practice of neurocritical care. Learn more about ON CALL®.

This episode is sponsored by ceribell.

Time is brain when it comes to seizures. Ceribell Point of Care EEG empowers the bedside team to detect or rule out seizure activity in minutes. To learn more, visit ceribell.com.

The NCS Podcast is the official podcast of the Neurocritical Care Society.

Dr Yasser Abulhasan, MBChB, FRCPC, FNCS, discusses how the Emirates Critical Care Conference has evolved over time and partnered with the Neurocritical Care Society to offer a neurocritical care track during the conference.

The purpose of informed consent, as it exists now, is primarily to maintain patient autonomy, but additional benefits include the protection of patients, avoidance of fraud, and promotion of rational decisions, amongst others. It is now considered both an ethical and legal obligation which should, at a minimum, always include: 1) the nature of the procedure, 2) the risks and benefits of the procedure, 3) reasonable alternatives, and 4) risks and benefits of alternatives, with an assessment of comprehension of these elements (1). This week Dr Lauren Koffman is joined by Clotilde Balucani, MD and Julia Durrant, MD two of the authors of the recent Currents article Consent for Brain Death Determination - the ends justify the means... or it does not.

We've had a blast in Phoenix and Casey Albin brings our podcast proceedings to a close with her highlihghts from the third and final day of #NCS2023. See you next year in San Diego (October 14-18, 2024)!

Mohammed Hirzallah joins Nick Morris to discuss improving the utility of optic nerve sheath diameter as a non-invasive intracranial pressure measurement through standardization and automation.

At the end of Day 2 of our Annual Meeting in Phoenix, Casey Albin, MD gives a shout out to her highlights from today's packed program. 

Following their debate on approaches to early phase management of refractory status epilepticus (RSE), Salia Farrokh, PharmD is joined by Caroline Der Nigoghossian, Neurocritical Care PharmD, Renad Abu-Sawwa, PharmD, and Gabe Fontaine, PharmD to explore the benefits and harms/risks of early ketamine administration in refractory status epilepticus, as well as the emerging literature for the use of ketamine in pediatric neurocritical care.