Continuous real-time monitoring of the adequacy of cerebral perfusion can provide important therapeutic information in a variety of clinical settings. The current clinical availability of several non-invasive near-infrared spectroscopy (NIRS)-based cerebral oximetry devices represents a potentially important development for the detection of cerebral ischaemia. In addition, a number of preliminary studies have reported on the application of cerebral oximetry sensors to other tissue beds including splanchnic, renal, and spinal cord. This review provides a synopsis of the mode of operation, current limitations and confounders, clinical applications, and potential future uses of such NIRS devices.

Near-infrared spectroscopy as an index of brain and tissue oxygenation

Near infrared spectroscopy (NIRS) is an imaging technique used in both clinical and emergency medicine, as well as in research laboratories to quantify and measure the oxygenation status of human tissue non-invasively. This is done by monitoring in vivo changes of the oxygen saturation of hemoglobin molecules in the body, based on the absorbance of near-infrared light by hemoglobin. With regards to NIRS in human tissue, this chapter will primarily be concerned with discerning the oxygenation status of cerebral tissue. The importance of such a measure, especially in cerebral physiology, is that the human brain utilizes oxygen to continuously supply neurons with energy used for vital body functioning. In the absence of oxygen, as is the case during ischemic stroke or desanguination, cognitive and functional impairment resulting in death often occurs. NIRS technology makes it possible to apply critical safety thresholds with regards to cerebral tissue saturation in order to avoid dangerously low levels with the primary goal being to reduce mortality rates and cognitive deficits due to cerebral hypoxemia.

Near infrared spectroscopy.

. Bowler I, Djaiani G, Abel R, Pugh S, Dunne J, Hall J. A combination of intrathecal morphine and remifentanil anesthesia for fast-track cardiac anesthesia and surgery. J Cardiothorac Vasc Anesth 2002; 16:709–714. [54] Brown J, McAtamney D. Remifentanil infusion for high-risk caesarean section. Int J Obstet Anesth 2003; 12:63–64. . Bruhn J, Bouillon TW, Radulescu L, et al. Correlation of approximate entropy, bispectral index, and spectral edge frequency 95 (SEF95) with clinical signs of ’anesthetic depth’ during coadministration of propofol and remifentanil. Anesthesiology 2003; 98:621–627. [13] Burmeister MA, Brauer P,Wintruff M, Graefen M, Blanc I, Standl TG. A comparison of anaesthetic techniques for shock wave lithotripsy: the use of a remifentanil infusion alone compared to intermittent fentanyl boluses combined with a low dose propofol infusion. Anaesthesia 2002; 57:877– 881. Burmeister MA, Standl TG, Wintruff M, Brauer P, Blanc I, Esch JSA. Dolasetron prophylaxis reduces nausea and postanaesthesia recovery time after remifentanil infusion duringmonitored anaesthesia care for extracorporeal shock wave lithotripsy. Br J Anaesth 2003; 90:194–198. Cavaliere F, Antonelli M, Arcangeli A, Conti G, Costa R, Pennisi MA, Proietti R. A low-dose remifentanil infusion is well tolerated for sedation in mechanically ventilated, critically-ill patients. Can J Anaesth 2002; 49:1088–1094.

Critical care: State of the art

CARDIOVASCULAR Near-infrared spectroscopy as an index of brain and tissue oxygenation

We highlight a significant problem that needs to be considered and addressed when performing functional near-infrared spectroscopy (fNIRS) studies, namely the possibility of inadvertently measuring fNIRS hemodynamic responses that are not due to neurovascular coupling. These can be misinterpreted as brain activity, i.e., "false positives" (errors caused by wrongly assigning a detected hemodynamic response to functional brain activity), or mask brain activity, i.e., "false negatives" (errors caused by wrongly assigning a not observed hemodynamic response in the presence of functional brain activity). Here, we summarize the possible physiological origins of these issues and suggest ways to avoid and remove them.

https://www.spiedigitallibrary.org/journals/neurophotonics/volume-3/issue-3/031405/False-positives-and-false-negatives-in-functional-near-infrared-spectroscopy/10.1117/1.NPh.3.3.031405.pdf

False positives and false negatives in functional near-infrared spectroscopy: issues, challenges, and the way forward

We have compared the effect of increasing optode separation (range 0.7-5.5 cm) on the sensitivity of near infrared spectroscopy (NIRS) to discrete reductions in scalp and cerebral oxygenation in 10 healthy men (mean age 32, range 26-39 yr) using multichannel NIRS. During cerebral oligaemia (a mean reduction in middle cerebral artery flow velocity of 47%) induced by a mean reduction in end-tidal PCO2 of 2.4 kPa, the decrease in oxyhaemoglobin detected by NIRS became significantly greater with increasing optode separation (P

Cerebral near infrared spectroscopy: emitter-detector separation must be increased.

To test theoretical assumptions supporting the use of near-infrared spectroscopy (NIRS) in clinical practice, we examined the behaviour of NIR light transmission and attenuation in the human head. Sterile probes for emitting and detecting NIR light at a fixed separation of 40 mm were placed in turn on intact skin, skull, dura and cerebral cortex of 10 patients undergoing elective neurosurgery. In the first five patients, the detecting probe was moved through successive extracerebral layers with the emitter on the skin surface. In the second five patients, the process was reversed, with the emitting probe moved and the detector in the same place on the scalp. NIR intensity was measured at each tissue interface and compared with the intensity measured at the skin surface with all layers intact. Removal of bone and dura from the light path caused a significant reduction in detected intensity. The largest mean reduction in light intensity was a 14-fold decrease with removal of bone (unadjusted P

Behaviour of near-infrared light in the adult human head: implications for clinical near-infrared spectroscopy.

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Cerebral near infrared spectroscopy: emitter-detector separation must be increased.

Behaviour of near-infrared light in the adult human head: implications for clinical near-infrared spectroscopy.