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Roldan, M. Near-Infrared Spectroscopy in TBI. Encyclopedia. Available online: https://encyclopedia.pub/entry/8117 (accessed on 16 November 2024).
Roldan M. Near-Infrared Spectroscopy in TBI. Encyclopedia. Available at: https://encyclopedia.pub/entry/8117. Accessed November 16, 2024.
Roldan, Maria. "Near-Infrared Spectroscopy in TBI" Encyclopedia, https://encyclopedia.pub/entry/8117 (accessed November 16, 2024).
Roldan, M. (2021, March 18). Near-Infrared Spectroscopy in TBI. In Encyclopedia. https://encyclopedia.pub/entry/8117
Roldan, Maria. "Near-Infrared Spectroscopy in TBI." Encyclopedia. Web. 18 March, 2021.
Near-Infrared Spectroscopy in TBI
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This entry is adapted from the peer-reviewed paper 10.3390/s21051586

Traumatic brain injury (TBI) occurs when a sudden trauma causes damage to the brain. TBI can result when the head suddenly and violently impacts an object or when an object pierces the skull and enters brain tissue. Secondary injuries after traumatic brain injury (TBI) can lead to impairments on cerebral oxygenation and autoregulation. Considering that secondary brain injuries often take place within the first hours after the trauma, noninvasive monitoring might be helpful in providing early information on the brain’s condition. Near-infrared spectroscopy (NIRS) is an emerging noninvasive monitoring modality based on chromophore absorption of infrared light with the capability of monitoring perfusion of the brain. This study investigates the main applications of NIRS in TBI monitoring and presents a thorough revision of those applications on oxygenation and autoregulation monitoring. Databases such as PubMed, EMBASE, Web of Science, Scopus, and Cochrane library were utilized in identifying 72 publications spanning between 1977 and 2020 which were directly relevant to this study. The majority of the evidence found used NIRS for diagnosis applications, especially in oxygenation and autoregulation monitoring (59%).

near infrared spectroscopy traumatic brain injury cerebral oxygenation cerebral autoregulation

1. Introduction

Traumatic brain injury (TBI) is defined as an alteration in brain function or pathology caused by an external force. Based on psychological and anatomical features evaluated by scales such as the Glasgow Coma Scale, TBI can be categorized into mild, moderate, or severe [1]. It is estimated that there are 50 million new cases of TBI every year worldwide [2]. The incidence rate of TBI has increased 3.6% in the last 30 years, and it has been predicted that it will remain the most important cause of disability from neurological disease until 2030, even two to three times higher than the contribution from Alzheimer’s disease [2]. According to the European Union statistics, there are 1.5 million hospital admissions due to TBI per year, with a mortality rate between 30% and 40%, with one person dying every 10 min because of head trauma [2]. The treatment costs associated with TBI are estimated to be around $400 billion annually, resulting in approximately $55,000 per patient [3]. These financial values do not take into account the rehabilitation cost (10% higher than hospitalisation costs) and all the other indirect expenses such as productivity loss, disability, and reduction of quality of life [4].

The most common mechanism of injuries which can cause TBI are hits, falls, violence, concussion, shaken baby syndrome, blast, and whiplash [5][6][7][8][9][10][11]. Patients may suffer unavoidable injuries such as fractures leading to deformation or destruction of brain tissue, whereas avoidable secondary injuries such as swelling and hematomas, which compress vital brain structures and displace the brain midline, may also take place. In many cases, those secondary injuries are followed by obstructions of cerebrospinal fluid (CSF) paths—generating hydrocephalus—as well as blockage of arteries which may result in ischemia. These damages can also alter autoregulation capacity, increase intracranial pressure, and reduce blood pressure to the brain, which, in turn, can all lead to brain hypoxia [12][13].

2. Assessing TBI

Considering that secondary brain injuries often take place within the first hours after a trauma, noninvasive monitoring might be helpful in providing early information on the brain’s condition [14]. Unfortunately, continuous and noninvasive monitoring of brain’s hemodynamics is scarcely available, even for severe cases of TBI [15]. Current clinical practices primarily utilize invasive methods for assessing TBI. Such methods include probes and/or catheters to measure intracranial pressure (ICP), brain temperature (BT), brain oxygen tension (PbtO2), neurochemistry via microdialysis (MD), cerebral blood flow (CBF), and jugular oxygen saturation (SjvO2) [16]. The aforementioned approaches introduce additional risks and require neurosurgical expertise, thus potentially causing delays in providing useful clinical information [17][18]. Furthermore, studies have shown that an initial phase of cerebral hypoperfusion, which is not assessed and treated on time during the early post-traumatic period, can contribute to increased mortality and worsened neurological outcome in 60–80% of TBI patients [15][18]. Imaging techniques such as computerized tomography (CT) and magnetic resonance imaging (MRI) could provide a solution to the above challenges, but such techniques cannot be used for continuous monitoring of TBI at the bed site [19].

3. Near-Infrared Spectroscopy in TBI

In consequence, an ideal neuromonitoring system should be continuous, affordable, noninvasive, and suitable for bedside use or in field monitoring (i.e., ambulances) [20]. Since 1977, when near-infrared spectroscopy (NIRS) was first described for monitoring cerebral perfusion and brain oxygenation [21], clinical interest on this optical technology has increased. Near-infrared (NIR) represents wavelengths within the range of 700 nm and 1000 nm, where the absorption contribution of chromophores such as oxygenated and deoxygenated hemoglobin is maximized, while the absorption contribution of other compounds such as water molecules is minimized. NIR light can penetrate bony structures and several millimetres into cerebral tissue, where according to Beer–Lambert law, light absorption is directly proportional to the concentration of chromophores. The reflected light attenuation represents information regarding regional cerebral oxygen saturation (rSO2) and the balance between oxygen delivery and oxygen consumption, making NIRS a very sensitive technology to changes in cerebral oxygenation [22]. Based on the aforementioned, NIRS could potentially address ideal neuromonitoring requirements, detect brain tissue at risk of secondary injury, and complement or even replace current invasive practices [23][24]. Overall, current evidence suggests that NIRS allows the detection of intracranial bleeding, the assessment of brain tissue oxygenation and cerebral perfusion. NIRS has also been applied in the evaluation of cerebral autoregulation and intracellular metabolic state during the early post-traumatic period. Furthermore, this optical technique can be also applied during neurorehabilitation [23].

References

  1. Brazinova, A.; Rehorcikova, V.; Taylor, M.S.; Buckova, V.; Majdan, M.; Psota, M.; Peeters, W.; Feigin, V.; Theadom, A.; Holkovic, L. Epidemiology of Traumatic Brain Injury in Europe: A Living Systematic Review. J. Neurotrauma 2018.
  2. Maas, A.I.R.; Menon, D.K.; Adelson, D.; Andelic, N.; Bell, M.J.; Belli, A.; Bragge, P.; Brazinova, A.; Büki, A.; Chesnut, R.M.; et al. The Lancet Neurology Commission Traumatic brain injury: Integrated approaches to improve prevention, clinical care, and research Executive summary The Lancet Neurology Commission. Lancet Neurol 2017, 16, 987–1048.
  3. Van Dijck, J.T.J.M.; Dijkman, M.D.; Ophuis, R.H.; de Ruiter, G.C.W.; Peul, W.C.; Polinder, S. In-hospital costs after severe traumatic brain injury: A systematic review and quality assessment. PLoS ONE 2019, 14, e0216743.
  4. Dismuke, C.E.; Walker, R.J.; Egede, L.E. Utilization and Cost of Health Services in Individuals with Traumatic Brain Injury. Glob. J. Health Sci. 2015, 7, 156–169.
  5. Helmick, K.M.; Spells, C.A.; Malik, S.Z.; Davies, C.A.; Marion, D.W.; Hinds, S.R. Traumatic brain injury in the US military: Epidemiology and key clinical and research programs. Brain Imaging Behav. 2015, 9, 358–366.
  6. Carney, N.; Ghajar, J.; Jagoda, A.; Bedrick, S.; Davis-O’Reilly, C.; Du Coudray, H.; Hack, D.; Helfand, N.; Huddleston, A.; Nettleton, T.; et al. Concussion guidelines step 1: Systematic review of prevalent indicators. Neurosurgery 2014, 75.
  7. Corrigan, J.D.; Harrison-Felix, C.; Haarbauer-Krupa, J. Epidemiology of Traumatic Brain Injury. In Textbook of Traumatic Brain Injury; Silver, J.M., McAllister, T.W., Arciniegas, D.B., Eds.; American Psychiatric Association Publishing: Washington, DC, USA, 2018; pp. 3–24. ISBN 9781615371129.
  8. Rowson, B.; Rowson, S.; Duma, S.M. Biomechanical Forces Involved in Brain Injury. In Textbook of Traumatic Brain Injury; Silver, J.M., McAllister, T.W., Arciniegas, D.B., Eds.; American Psychiatric Association Publishing: Washington, DC, USA, 2018; pp. 25–39. ISBN 9781615371129.
  9. Williams, W.H.; Chitsabesan, P.; Fazel, S.; McMillan, T.; Hughes, N.; Parsonage, M.; Tonks, J. Traumatic brain injury: A potential cause of violent crime? Lancet Psychiatry 2018, 5, 836–844.
  10. Macdonald, A.; Ayton, D.; Pritchard, E.; Tsindos, T.; O’brien, P.; Dr, M.K.; Braaf, S.; Berecki-Gisolf, J.; Hayman, J. Informing the Response to Recommendation 171 of the Victorian Royal Commission into Family Violence; Brain Injury Australia: Sydney, 2018; ISBN 978-0-6482640-1-9.
  11. Mian, M.; Shah, J.; Dalpiaz, A.; Schwamb, R.; Miao, Y.; Warren, K.; Khan, S. Shaken baby syndrome: A review. Fetal Pediatr. Pathol. 2015, 34, 169–175.
  12. Stocker, R.A. Intensive Care in Traumatic Brain Injury Including Multi-Modal Monitoring and Neuroprotection. Med. Sci. 2019, 7, 37.
  13. Herklots, M.W.; Moudrous, W.; Oldenbeuving, A.; Roks, G.; Mourtzoukos, S.; Schoonman, G.G.; Ganslandt, O. Prospective Evaluation of Noninvasive HeadSense Intracranial Pressure Monitor in Traumatic Brain Injury Patients Undergoing Invasive Intracranial Pressure Monitoring. World Neurosurg. 2017, 106, 557–562.
  14. Ko, S.-B. Multimodality Monitoring in the Neurointensive Care Unit: A Special Perspective for Patients with Stroke. J. Stroke 2013, 15, 99.
  15. Mazzeo, A.T.; Gupta, D. Monitoring the injured brain. J. Neurosurg. Sci. 2018, 62, 549–562.
  16. Vinciguerra, L.; Bösel, J. Noninvasive Neuromonitoring: Current Utility in Subarachnoid Hemorrhage, Traumatic Brain Injury, and Stroke. Neurocrit. Care 2017, 27, 122–140.
  17. Martin, M.; Lobo, D.; Bitot, V.; Couffin, S.; Escalard, S.; Mounier, R.; Cook, F. Prediction of Early Intracranial Hypertension After Severe Traumatic Brain Injury: A Prospective Study. World Neurosurg. 2019, 127, e1242–e1248.
  18. Sokoloff, C.; Williamson, D.; Serri, K.; Albert, M.; Odier, C.; Charbonney, E.; Bernard, F. Clinical Usefulness of Transcranial Doppler as a Screening Tool for Early Cerebral Hypoxic Episodes in Patients with Moderate and Severe Traumatic Brain Injury. Neurocrit. Care 2019.
  19. Wilde, E.A.; Little, D. Clinical Imaging. In Textbook of Traumatic Brain Injury; Silver, J.M., McAllister, T.W., Arciniegas, D.B., Eds.; American Psychiatric Association Publishing: Washington, DC, USA, 2018; ISBN 9781615371129.
  20. Roldan, M.; Abay, T.Y.; Kyriacou, P.A. Non-invasive techniques for multimodal monitoring in Traumatic Brain Injury (TBI): Systematic review and meta-analysis. J. Neurotrauma 2020, 37, 2445–2453.
  21. Jöbsis, F.F. Noninvasive, Infrared Monitoring of Cerebral and Myocardial Oxygen Sufficiency and Circulatory Parameters. Science 1977, 23, 1264–1267.
  22. Oxiplex, T.S. A non-invasive, real-time monitor of precise tissue oxygenation and hemoglobin concentration. Newt. Drive 2001, 6. Available online: (accessed on 24 February 2020).
  23. Weigl, W.; Milej, D.; Janusek, D.; Wojtkiewicz, S.; Sawosz, P.; Kacprzak, M.; Gerega, A.; Maniewski, R.; Liebert, A. Application of optical methods in the monitoring of traumatic brain injury: A review. J. Cereb. Blood Flow Metab. 2016, 36, 1825–1843.
  24. Mathieu, F.; Khellaf, A.; Ku, J.C.; Donnelly, J.; Thelin, E.P.; Zeiler, F.A. Continuous Near-Infrared Spectroscopy Monitoring in Adult Traumatic Brain Injury. J. Neurosurg. Anesthesiol. 2019.
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