Cerebral oxygenation monitoring by near-infrared spectroscopy is not clinically useful in patients with severe closed-head injury

✓ A multimodality recording system was used in 14 ventilated patients with closed head injury to assess the potential use of near-infrared spectroscopy (NIRS) in the neurointensive care unit. Signals of intracranial pressure, cerebral perfusion pressure, peripheral oxygen saturation, jugular venous saturation, and NIRS-derived changes in the chromophores of oxy- and deoxyhemoglobin were digitized and recorded. After a review of 886 hours of continuous monitoring, 376 hours were considered free from artifact and were entered for final analysis. In nine of the patients 38 events were recorded that demonstrated clear changes in cerebral perfusion pressure accompanied by hemodynamic changes in middle cerebral artery flow velocity (transcranial Doppler) and cortical perfusion (laser Doppler flowmetry). Near-infrared spectroscopy showed correlated changes in 37 events (97%) whereas jugular venous saturation monitoring registered only 20 (53%). There was associated peripheral oxygen desaturation in eight cases (21%), intracranial hypertension in 10 (26%), and cerebral hyperemia in eight (21%). The remaining 12 events (32%) appeared to be complex changes of uncertain origin. Iatrogenic factors were identified as causative in 14 cases (37%). The potential application of NIRS in adults and the importance of using multiple parameter recording systems in the interpretation of cerebral events are discussed.

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A near-infrared spectroscopy system for cerebral oxygenation monitoring

Proceedings of the 2014 International Conference on Innovative Design and Manufacturing (ICIDM) ◽

10.1109/idam.2014.6912665 ◽

2014 ◽

Author(s):

Xue Han ◽

Marco Bestonzo ◽

Filippo Molinari

Keyword(s):

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Cerebral Oxygenation ◽

Spectroscopy System ◽

Oxygenation Monitoring

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Cerebral oxygenation monitoring: near-infrared spectroscopy

Expert Review of Medical Devices ◽

10.1586/17434440.3.2.235 ◽

2006 ◽

Vol 3 (2) ◽

pp. 235-243 ◽

Cited By ~ 74

Author(s):

Joseph D Tobias

Keyword(s):

Infrared Spectroscopy ◽

Near Infrared Spectroscopy ◽

Near Infrared ◽

Cerebral Oxygenation ◽

Oxygenation Monitoring

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Near-infrared spectroscopy as a predictor of cerebral ischaemia during carotid endarterectomy in awake patients

Vascular ◽

10.1177/1708538119893830 ◽

2020 ◽

Vol 28 (3) ◽

pp. 301-308

Author(s):

Donatas Inčiūra ◽

Aleksandras Antuševas ◽

Adomas Aladaitis ◽

Agnė Gimžauskaitė ◽

Linas Velička ◽

...

Keyword(s):

Infrared Spectroscopy ◽

Carotid Endarterectomy ◽

Near Infrared Spectroscopy ◽

Cerebral Ischaemia ◽

Local Anaesthesia ◽

Near Infrared ◽

Internal Carotid ◽

Cerebral Oxygenation ◽

Stump Pressure ◽

Oxygenation Monitoring

Objectives The aim of our study was to evaluate the near-infrared spectroscopy monitoring system to detect cerebral ischaemia, find indications for selective shunting during carotid endarterectomy and compare it with an internal carotid artery stump pressure monitoring technique in patients operated under local anaesthesia. Methods During January 2015 and November 2018, 131 patients undergoing carotid endarterectomy under local anaesthesia were prospectively included in the study. Near-infrared spectroscopy as intraoperative monitoring was applied and compared with stump pressure. Results Carotid endarterectomy was performed successfully in 106 patients operated under local anaesthesia. Meanwhile, 25 patients developed neurological changes (motor or consciousness impairment, weakness of extremities, cognitive decline) during clamping, and all of them received a shunt. ΔrSO2, stump pressure and rSO2 (–11 ± 8%, 31 ± 6mmHg, 58 ± 11) values were smaller in the group of shunted subjects versus non-shunted group subjects (–2 ± 5%, 61 ± 17 mmHg, 64 ± 8) after 1 min of internal carotid artery clamping ( p < 0.05). Statistical analysis showed a sensitivity of 90% (95% CI: 0.85–0.95) and a specificity of 70% (95% CI: 0.62–0.78) for a ≥10% drop in ΔrSO2 to predict ischaemia symptoms during carotid clamping. Using stump pressure with a cut-off value of ≤40 mmHg for predicting symptoms, the sensitivity was 82% and specificity 54%. Conclusions Near-infrared spectroscopy is a suitable non-invasive cerebral oxygenation monitoring method during carotid endarterectomy. A 10% decrease of ΔrSO2 had a good correlation with clinical cerebral ischaemia signs and matched well with the stump pressure cut-off value of ≤40 mmHg. There is a possibility of near-infrared spectroscopy to replace stump pressure in cerebral oxygenation monitoring during carotid endarterectomy. However, we need larger prospective multicentre studies to identify the optimal threshold for shunt requirement.

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