The state of affairs of neurologic monitoring by near-infrared spectroscopy in pediatric cardiac critical care.
OBJECTIVE
The decreasing postoperative mortality in patients with congenital heart disease has enabled an increasing interest in preventing morbidity, especially from the central nervous system. Near-infrared spectroscopy, a noninvasive technology that provides an estimate of tissue oxygenation, has been introduced in the intensive care unit and has gained popularity over the last decade. This review aims to ascertain its ability to affect outcome.


RESULTS
Recent studies have started to incorporate cerebral near-infrared spectroscopy in the assessment, evolution, and outcomes of surgical patients with congenital heart disease. These studies often represent small single-center high-risk cohorts that are evaluated in a retrospective or an observational manner. Nevertheless, new data are starting to indicate that near-infrared spectroscopy may be helpful not only in the assessment of critical care parameters, such as cardiac output performance or likelihood of adverse events, but, most notably, in the long-term neurological outcome.


CONCLUSIONS
In addition to additional corroborative trials from different centers, a critical question that remains to be answered is whether targeting cerebral near-infrared spectroscopy values, as part of goal-directed therapy protocols, can help to improve outcome overall.
Section of Pediatric Critical Care Medicine, Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Samira
S
Neshat Vahid
Jose M
JM
Panisello
D002648:Child; D002675:Child, Preschool; D003422:Critical Care; D006330:Heart Defects, Congenital / Q000401:mortality / Q000503:physiopathology*; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008991:Monitoring, Physiologic / Q000379:methods*; D011237:Predictive Value of Tests; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D019265:Spectroscopy, Near-Infrared