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How to use near-infrared spectroscopy
  1. Peter Donnelly1,
  2. Miriam R Fine-Goulden2
  1. 1Paediatric Intensive Care Unit, Belfast Children’s Hospital, Belfast, UK
  2. 2Paediatric Intensive Care, Evelina Children’s Hospital, Guy’s and St. Thomas' NHS Foundation Trust, London, UK
  1. Correspondence to Dr Miriam R Fine-Goulden, Paediatric Intensive Care, Evelina Children’s Hospital, Guy’s and St. Thomas' NHS Foundation Trust, London, UK; miriam.finegoulden{at}gstt.nhs.uk

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Introduction

Near-infrared spectroscopy (NIRS) is a non-invasive, portable, continuous modality used to assess regional tissue oxygen saturations, expressed as a percentage. The introduction of NIRS into clinical practice is relatively recent, with its role in measuring cerebral oxygenation originally described in the 1970s.1 The first report of cerebral NIRS recording in humans was published in 1985 and by 1993 the first commercially produced NIRS monitors became available.2 Animal studies continued in the early 2000s3 which led the way for further trials in human subjects. Whilst there remains a paucity of data in the literature with respect to the clinical application of NIRS, it has been adopted widely and data continue to be amassed. Clinical applications of this technology include cerebral and cardiac monitoring, detection of global or regional low cardiac output states (LCOS), assessment of response to therapy and prognostication.4 NIRS is now commonly employed within the setting of cardiac surgery in both adults and children to monitor cerebral perfusion during cardiopulmonary bypass and is used increasingly in intensive care units in the post-operative period as a marker for LCOS.5 6 As awareness of and experience in the technology grows there is increasing interest in its utility in a wider range of circumstances, for example, to monitor distal limb perfusion for patients with large venous cannulae on extracorporeal membrane oxygenation (ECMO); however, it is yet to be validated across the range of scenarios in which it is currently applied.7 This is a promising technology which is non-invasive, continuous, easy to use and non-operator-dependent. In high-risk intensive care, patients who are otherwise difficult to monitor and may be sedated and on neuromuscular-blocking agents, NIRS provides the clinician with the opportunity for continuous assessment and early intervention.

Physiological background

The primary application of NIRS in paediatrics is in monitoring …

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