Neurocritical Care Society Podcast

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.

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.

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 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.

Dr. Nicholas Morris is joined by Prof. Jürgen Beck and Prof. Urs Fischer to discuss the SWITCH trial on decompressive craniectomy for deep intracerebral hemorrhage. They cover trial outcomes, analysis of secondary outcomes, serious adverse events, and advancements in intracerebral hemorrhage care.

Ashkan Shoamanesh discusses the ANNEXA-I Trial's impact on hematoma volume expansion in intracerebral hemorrhage patients on Factor Xa inhibitors. Topics include challenges in reversing effects, trial design, safety analyses, and clinical outcomes.

In this week's episode of Perspectives, Dr Nicholas Morris is joined by Dr Monisha Kumar, FNCS, Professor of Neurology at the Hospital of the University of Pennsylvania to discuss the threats to diversity, equity, and inclusion in neurocritical care.

As clinicians working with patients who have sustained an acute brain injury, we are naturally focused on caring for the injury itself. Until recent years, the clinical severity of brain injury was regarded as the main driver of prognosis and outcomes. However, we are beginning to understand how non-clinical factors, including the social determinants of health (SDOH), contribute to differential risk for all brain injuries including hemorrhagic stroke, and continue to impact our patients’ recovery even after injury. In this week's episode Dr Lauren Koffman is joined by Dr Nirupama Yechoor and Dr Rachel Forman to discuss how understanding the complex interplay between clinical and social determinants of health is crucial for clinicians caring for hemorrhagic stroke survivors, not only for recovery and secondary prevention, but also to effectively counsel families on primary prevention. Lauren is also joined by Mike Foster, a member of Yale's Stroke Patient Advisory Board who talks about his experience as a stroke survivor. You can read the Currents article at https://currents.neurocriticalcare.org/Leading-Insights/Article/innovation-for-health-disparities-research-in-hemorrhagic-stroke.  Stroke survivors or those who care for loved ones who have had a stroke can sign-up for Dr Yechoor's study at https://rally.massgeneralbrigham.org/study/strokewellbeing. 

Dr Jennifer Frontera discusses NCS Guidelines for Seizure Prophylaxis in TBI patients, focusing on challenges with seizure medications, inclusion criteria, and exploring different anti-seizure medications like phenytoin and levetiracetam. The discussion also includes guideline recommendation methodology, the role of Bayesian meta-analysis, and the effectiveness of anti-seizure medications in preventing seizures in adults with TBI.

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.