Near-Infrared Spectroscopy in the Critical Setting

Abstract

Near-infrared spectroscopy is a noninvasive means of determining real-time changes in regional oxygen saturation of cerebral and somatic tissues. Hypoxic neurologic injuries not only involve devastating effects on patients and their families but also increase health care costs to the society. At present, monitors of cerebral function such as electroencephalograms, transcranial Doppler, jugular bulb mixed venous oximetry, and brain tissue oxygenation monitoring involve an invasive procedure, are operator-dependent, and/or lack the sensitivity required to identify patients at risk for cerebral hypoxia. Although 20th century advances in the understanding and management of resuscitation of critically ill and injured children have focused on global parameters (ie, pulse oximetry, capnography, base deficit, lactate, etc), a growing body of evidence now points to regional disturbances in microcirculation that will lead us in a new direction of adjunctive tissue monitoring and response to resuscitation. In the coming years, near-infrared spectroscopy will be accepted as a way for clinicians to more quickly and noninvasively identify patients with altered levels of cerebral and/or somatic tissue oxygenation and, in conjunction with global physiologic parameters, guide efficient and effective resuscitation to improve outcomes for critically ill and injured pediatric patients.

High renal regional oxygen saturation in femoral arteriovenous fistula after neonatal cardiac surgery

“…NIRS uses 2 wavelengths to measure deoxygenated haemoglobin (Hb) and oxygenated Hb to provide the saturation (rSO 2 ) of blood 1–2 cm below the skin. Since there is more haemoglobin in the venous circulation compared to arterial circulation in the tissue, NIRS gives a venous-weighted relative oxygen index of tissue beneath the probe 1. Low ScvO 2 and rSO 2 are quite useful to diagnose and monitor LCOS, but high values are less often seen in day-to-day practice.…”

“…It is, therefore, part of the standard monitoring in critical care and especially after congenital cardiac surgery. Regional haemoglobin oxygen saturation (rSO 2 ) using near-infrared spectroscopy (NIRS) is a non-invasive technique which uses sensors placed on forehead and renal somatic area to estimate adequacy of oxygen delivery 1. Low ScvO 2 and low rSO 2 are the main concern for clinicians, because they have been associated with low cardiac output syndrome (LCOS) in this population 2–5.…”

The use of cerebral and somatic regional tissue oxygen saturation in monitoring of critically ill children who were admitted to the pediatric emergency department: A prospective descriptive study

“…Bu değer, ölçüm yapılan dokudaki arteriyel, venöz ve kapiller oksijenizasyonu yansıtmaktadır (3) . Beyin rSO 2 (BrSO 2 ) günü-müzde özellikle kardiyovasküler cerrahi ameliyatları sırasında sık olarak kullanılmasına rağmen, kardiyopulmoner canlandırma, post kardiyak arrest bakım, şok, kompartman sendromu, nekrotizan enterokolit gibi birçok alanda çalışmalar devam etmektedir (4) . Kritik hastalarda kompansasyon mekanizmaları nedeni ile beyin perfüzyonu korunmakta ve mezenter perfüzyonu daha önce bozulmaktadır.…”

Сerebral oxymetry in neonatology

“…Особое внимание исследователи уделяют окси-метрии мозга у глубоко недоношенных детей, ко-торые могут испытывать церебральную гипоксию или гипероксию в связи с реанимационными меро-приятиями и тяжестью дыхательных расстройств, сопровождающихся нестабильностью гемодинамики [12,33]. Показано, что у детей с очень низкой мас-сой тела уже к 7-й минуте жизни сатурация кисло-рода в ткани мозга составляет 61-84 % [15].…”