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Near-Infrared Spectroscopy in the Critical Setting

Drayna, Patrick C. MD*; Abramo, Thomas J. MD, FAAP, FACEP*†‡§; Estrada, Cristina MD*‡∥

doi: 10.1097/PEC.0b013e3182188442
CME Review Article

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.

Pediatric Emergency Fellow and Clinical Instructor (Drayna), Professor (Abramo), and Assistant Professor (Estrada) in *Emergency Medicine and Pediatrics; Director (Abramo) of †Pediatric Emergency Medicine, Department of Pediatrics; Director (Abramo) and ‡Associate Director (Estrada) of Pediatric Emergency Medicine Fellowship Program; §Medical Director of Pediatric Transport (Abramo); and ∥Assistant Residency Director (Estrada), Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN.

Reprints: Patrick C. Drayna, MD, 2200 Children's Way, Division of Pediatric Emergency Medicine, 1014 VCH, Nashville, TN 37232-9001 (e-mail:

All authors and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations pertaining to this educational activity.

© 2011 Lippincott Williams & Wilkins, Inc.