HOT TOPICS: Neuroprognostication in Acute Ischemic Stroke

HOT TOPICS: Neuroprognostication in Acute Ischemic Stroke

In this episode of the NCS Podcast Hot Topics series, host Rich Choi, MD, is joined by Alejandro Rabinstein, MD, Shraddha Mainali, MD, and Krishna Rajajee, MD, to discuss the article "Guidelines for Neuroprognostication in Critically Ill Adults With Acute Ischemic Stroke [https://link.springer.com/article/10.1007/s12028-026-02486-3]," published in Neurocritical Care. Their conversation explores the development of the guideline, including the need for a more structured, evidence-based approach to prognostication in critically ill patients with acute ischemic stroke. The guests discuss why early prognostication is especially high-stakes, how uncertainty and the risk of self-fulfilling prophecy shaped the recommendations and why no single clinical variable or prediction model is reliable enough to guide individual decisions about poor outcomes. They also review the role of early neurological improvement as a moderately reliable predictor of good outcomes, the limitations of existing prediction models in the era of reperfusion therapy, and the importance of multimodal assessment, ongoing family conversations, long-term outcome counseling and shared decision-making rooted in each patient's values. 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.

PERSPECTIVES: Moving Evidence Into Practice With Molly McNett

In this episode of the NCS Podcast Perspectives series, host Nicholas Morris, MD, and co-host Tom Lawson, PhD, ACNP-BC, FNCS, speak with Molly McNett, PhD, RN, CNRN, FNCS, FAAN, about her career in neurocritical care and the role of implementation science in translating research evidence into routine clinical practice. Dr. McNett reflects on her early experiences as an ICU nurse, the disconnect she observed between published evidence and bedside care and how those experiences shaped her work in research, guideline development and implementation science. The conversation explores the distinction between implementation science and quality improvement, common barriers to practice change and the importance of identifying local facilitators, workflows and organizational needs. Dr. McNett discusses examples such as automated pupillometry and fall-prevention practices, highlighting how implementation strategies and hybrid research designs can help healthcare teams adopt and sustain evidence-based care. The discussion also examines interdisciplinary collaboration, mentorship and opportunities for nurses and advanced practice providers interested in research. Dr. McNett shares practical advice for clinicians seeking to address evidence-to-practice gaps, including finding mentors, participating in research teams and developing a deeper understanding of individual and organizational behavior change. 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.

CURRENTS: Story of Hope — Vanessa Abraham's Journey of Recovery

In this episode of the NCS Podcast Currents series, host Lauren Koffman, DO, MS, speaks with Vanessa Abraham, MS, CCC-SLP, and Jared Rosen, MD, about Vanessa's Story of Hope and the lasting connection they formed during her neurocritical care journey. Vanessa shares how a sudden illness progressed from flu-like symptoms to respiratory failure and paralysis, ultimately requiring mechanical ventilation, an prolonged ICU stay and inpatient rehabilitation. She discusses the uncertainty surrounding her eventual diagnosis of a rare pharyngeal-cervical-brachial variant of Guillain-Barré syndrome, as well as the fear of being unable to communicate, care for her daughter or return to the life she knew before her illness. The conversation also explores the profound impact of compassionate, patient-centered care. Vanessa reflects on how Dr. Rosen, then a medical student completing an ICU rotation, became a reassuring presence for both her and her husband. Together, they discuss the importance of recognizing intubated patients as active participants in their care, providing accessible communication tools and taking time to listen. They also emphasize how small acts of empathy and human connection can reduce anxiety and potentially lessen the long-term effects of post-intensive care syndrome. To read Vanessa's full Story of Hope, visit NCS Currents [https://currents.neurocriticalcare.org/Stories-of-Hope/Article/finding-her-voice-again-vanessas-story-of-hope]. 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.

MASTERCLASS: Managing Respiratory Infections in the ICU

In this episode of the Neurocritical Care Society Podcast Masterclass series, hosts Stephan Mayer, MD, FCCM, FNCS, and Jon Rosenberg, MD, are joined by Richard Wunderink, MD, professor of medicine at Northwestern University Feinberg School of Medicine and pulmonary critical care intensivist, to discuss the diagnosis and management of respiratory infections in the ICU. Dr. Wunderink highlights why ventilator-associated pneumonia and suspected respiratory infections are common challenges across critical care settings, particularly among patients with acute neurologic injury, aspiration risk and prolonged mechanical ventilation. The discussion focuses on practical, bedside approaches to pneumonia management, including the limitations of tracheal aspirates and the risks of antibiotic overuse. The group also examines the role of bronchoalveolar lavage and the value of adjunctive diagnostic tools such as quantitative cultures, cell counts, Gram stains, amylase testing and molecular panels. They further explore how rapid diagnostics can help clinicians make more targeted antibiotic decisions, support earlier de-escalation when appropriate and prompt consideration of non-pulmonary causes of fever or clinical instability when pneumonia is unlikely. 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.

MASTERCLASS: What CREST-2 Means for Carotid Disease Management

In this episode of the Neurocritical Care Society Podcast Masterclass series, hosts Stephan Mayer, MD, FCCM, FNCS, and Jon Rosenberg, MD, are joined by Seemant Chaturvedi, MD, professor of neurology and director of the Stroke Division at the University of Maryland, for an in-depth discussion on carotid disease, stroke prevention and the role of revascularization in clinical practice. The episode explores the historical impact of NASCET, key findings from the CREST-2 trial and the role of intensive medical management for patients with asymptomatic carotid stenosis. Dr. Chaturvedi also shares practical guidance for neurointensivists caring for patients with symptomatic carotid disease, including intervention timing, risk stratification and emerging diagnostic tools such as MRI plaque imaging and TCD microemboli monitoring. 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.