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.