The use of near infrared spectroscopy (NIRS) in children after traumatic brain injury: a preliminary report.

Children commonly develop diffuse cerebral swelling after traumatic brain injury (TBI) which is believed due to a secondary response to the injury. Near infrared spectroscopy (NIRS), a continuous, direct, and noninvasive monitor of cerebral oxygenation and cerebral blood volume (CBV), could be helpful in understanding these secondary responses. The aims of our study were to determine whether NIRS used in children with severe TBI will provide insight into the pathophysiology of injury. Ten children (1 mo to 15 years old) with severe TBI (admission GCS < or = 7) were continuously monitored by NIRS by placing optodes over the frontalparietal region. Relative values of oxyhemoglobin (HbO2), deoxyhemoglobin (Hb), and total hemoglobin (THb) were obtained and compared to intracranial pressure (ICP), mean arterial pressure (MAP), electroencephalography (EEG), and arterial PCO2 (PaCO2). Episodes of intracranial hypertension (ICP > 20 Torr [T]), changes in ICP > 10 T, changes in PaCO2 > or = 8 T, and changes in MAP > 20 T frequently resulted in changes in HbO2, Hb, and THb. Hyperventilation with decreased PaCO2 always resulted in cerebral oxygen desaturation irregardless of ICP. Often, high ICP correlated with increased THb and HbO2 indicating increased CBV and cerebrovascular dilatation. In two children, posttraumatic seizures were preceded by an unexplained rapid cerebral hyperoxygenation several hours prior to the onset of the clinical seizures. NIRS reliably detects changes in cerebral hemodynamics in children and may be used to further understand the etiology of the diffuse cerebral swelling seen in children after severe TBI.