Near infrared spectroscopy in children at high risk of low perfusion.
OBJECTIVE
Tissue oximetry has been suggested as a noninvasive tool to continuously monitor and detect states of low body perfusion. This review summarizes recent developments and available data on the use of near infrared spectroscopy (NIRS) in children at risk for low perfusion.


RESULTS
During states of low cardiac output, cerebral blood flow and thus cerebral NIRS may be better preserved than in somatic tissue sites. Consequently, sites other than the frontal cerebral cortex have been investigated for a possible correlation with invasive measures of systemic perfusion and oxygenation (e.g. abdomen, flank, and muscle). The abdominal site seems preferable to the flank site NIRS (kidney region) application. In order to increase the sensitivity, specificity, and positive predictive value of tissue oximetry to detect systemic hypoperfusion, multisite NIRS such as a combination of cerebral and somatic site NIRS has been suggested. NIRS has also been used to assess systemic perfusion in patients undergoing first-stage palliation for hypoplastic left heart syndrome.


CONCLUSIONS
Despite shortcomings in the ability of NIRS technology to accurately reflect validated and directly measured parameters of systemic oxygen delivery and blood flow, NIRS can certainly assist in the detection of low-flow states (low cardiac output). Large, randomized, prospective studies with well defined outcome parameters are still missing and warranted in order to clearly define the role of NIRS in children at risk for low perfusion.
Mittnacht
Alexander J C
AJ
Department of Anesthesiology, Mount Sinai Medical Center, New York 10029, USA. alexander.mittnacht@mountsinai.org
D000005:Abdomen / Q000098:blood supply; D002303:Cardiac Output, Low; D002540:Cerebral Cortex / Q000098:blood supply; D002560:Cerebrovascular Circulation; D002675:Child, Preschool; D006801:Humans; D018636:Hypoplastic Left Heart Syndrome; D007223:Infant; D007231:Infant, Newborn; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D010092:Oximetry; D012039:Regional Blood Flow; D012306:Risk; D019265:Spectroscopy, Near-Infrared / Q000379:methods*