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CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2016; 03(04): S66-S69
DOI: 10.4103/2348-0548.174740
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Thieme Medical and Scientific Publishers Private Ltd.

Near-infrared spectroscopy—current status

Gyaninder P. Singh
1   Assistant Professor, Department of Neuroanaesthesiology and Critical Care, AIIMS, New Delhi, India
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Publication Date:
05 May 2018 (online)

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INTRODUCTION

Near-infrared spectroscopy (NIRS) is a non-invasive technique for measuring regional oxygen saturation (rsO2). It provides real-time information of changes in rSO2 of cerebral and somatic tissues. It can provide an early warning of decreased oxygen delivery. Tissue ischaemia is a significant contributor to increased morbidity and mortality, and thus measurement of tissue oxygenation is of paramount importance in critical care settings. In 1977, Franz Jöbsis first observed that light in the near-infrared light spectrum (wavelength 700–950 nm) can traverse biological tissue because of the relative transparency of tissue to light in this wavelength range.[1] This discovery later led to the development of NIRS technique to measure tissue oxygen saturation.

NIRS relies on ‘Beer-Lambert law’ (i.e., measurement of a substance concentration based on its absorption of light). Thus, measurement is based on determining haemoglobin oxygenation according to the light absorbed by haemoglobin.[2] The absorption of light is proportional to the concentration of certain chromophore molecules, mainly iron in haemoglobin and copper in cytochrome. In the brain, the primary infra-red light absorbing molecules are metal complex chromophores, namely, oxyhaemoglobin, deoxyhaemoglobin and cytochrome-C oxidase. Because about 70% of the blood in the brain is in the veins and capillaries and 25% in the arteries, most of the haemoglobin is in the venous circulation. Thus, NIRS gives a venous-weighted relative oxygen index of tissue beneath the probe.[3] [4] Cerebral oximetry does not depend on pulsatility of blood flow, unlike pulse oximetry.

The NIRS sensors are applied on either side of the forehead on a clean, dirt-free, non-greasy and non-hairy part of the skin. Each NIRS sensor (optodes) has a light-emitting source and two photodetectors integrated into a self-adhesive rubber plate that is attached to the forehead. The emitter and detectors are situated 4–8 cm apart. Light is generated at specific wavelengths typically by light-emitting diodes, and is usually detected by silicon photodiodes. The light emitted from the emitter passes through the scalp, skull bone and brain tissue. The photodetectors capture the reflected light from the underlying tissue. The light detected by the photodetector close to the emitter passes through the scalp and skull bone, while the light detected by the photodetector farther from the emitter passes through the brain tissue [Figure 1]. Near field photodetection is then substracted from far field photodetection to provide a measurement of brain tissue oxygenation.

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Figure 1: The placement of near-infrared spectroscopy sensors over the forehead and the path of near-infrared light from emitter to 2 detectors

In adults, bilateral frontal cerebral oximetry is used to monitor perfusion to at-risk areas of grey matter within cerebral cortex in the watershed areas between the anterior cerebral artery and middle cerebral artery. The smaller head circumference of neonates and children permits greater depth of penetration and assessment of subcortical tissue oxygenation. The sensors illuminate up to a volume of 10 ml of hemispherical tissue.

There have been several attempts to determine the normal and critical value of regional cerebral oxygen saturation (rScO2). However, data on cut-off values are still limited. The normal values of rScO2 are reported to be 60–80% in various studies. In an animal study, a decrease of the absolute value of rScO2 below 50% was associated with electroencephalogram abnormalities, and a further decrease in rScO2 below 40% lead to increased brain lactate levels.[5] Absolute rScO2 values below 50% have been repeatedly shown to be associated with an unfavourable clinical and/or neurological outcomes. Fischer et al. observed that a decrease in rScO2 below 60% absolute was associated with an increased complication rate in patients undergoing aortic arch surgery.[6] Tang et al. found the incidence of post-operative cognitive dysfunction increased in patients undergoing thoracic surgery even if rScO2 decreased below 65% for more than 5 min.[7] It is more appropriate to interpret the trend changes in rScO2, rather than absolute values.[8] A 20% decline in rScO2 from baseline is considered to be ischaemic threshold.[9] [10] In general, a decrease in rScO2 is reflective of an increase in oxygen extraction as a result of increased metabolism, decreased perfusion and/or stagnant perfusion. High rScO2 may be indicative of increased perfusion, decreased tissue bed metabolism and/or less oxygen extraction.

 

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