Gomez Alwyn, Sainbhi Amanjyot Singh, Froese Logan, Batson Carleen, Alizadeh Arsalan, Mendelson Asher A, Zeiler Frederick A
Section of Neurosurgery, Department of Surgery, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Department of Human Anatomy and Cell Science, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
Front Pharmacol. 2021 Nov 5;12:719501. doi: 10.3389/fphar.2021.719501. eCollection 2021.
Multimodal monitoring has been gaining traction in the critical care of patients following traumatic brain injury (TBI). Through providing a deeper understanding of the individual patient's comprehensive physiologic state, or "physiome," following injury, these methods hold the promise of improving personalized care and advancing precision medicine. One of the modalities being explored in TBI care is near-infrared spectroscopy (NIRS), given it's non-invasive nature and ability to interrogate microvascular and tissue oxygen metabolism. In this narrative review, we begin by discussing the principles of NIRS technology, including spatially, frequency, and time-resolved variants. Subsequently, the applications of NIRS in various phases of clinical care following TBI are explored. These applications include the pre-hospital, intraoperative, neurocritical care, and outpatient/rehabilitation setting. The utility of NIRS to predict functional outcomes and evaluate dysfunctional cerebrovascular reactivity is also discussed. Finally, future applications and potential advancements in NIRS-based physiologic monitoring of TBI patients are presented, with a description of the potential integration with other omics biomarkers.
多模态监测在创伤性脑损伤（TBI）患者的重症监护中越来越受到关注。通过更深入地了解个体患者受伤后的综合生理状态，即“生理组”，这些方法有望改善个性化护理并推动精准医学的发展。鉴于近红外光谱（NIRS）的非侵入性以及检测微血管和组织氧代谢的能力，它是TBI护理中正在探索的一种监测方式。在这篇叙述性综述中，我们首先讨论NIRS技术的原理，包括空间分辨、频率分辨和时间分辨变体。随后，探讨NIRS在TBI临床护理各阶段的应用。这些应用包括院前、术中、神经重症监护以及门诊/康复环境。还讨论了NIRS预测功能结局和评估脑血管反应性障碍的效用。最后，介绍了基于NIRS的TBI患者生理监测的未来应用和潜在进展，并描述了与其他组学生物标志物潜在整合的情况。
