Application of Near-Infrared Spectroscopy for the Detection of Delayed Cerebral Ischemia in Poor-Grade Subarachnoid Hemorrhage

Abstract

Background The objective of this study was to investigate the clinical feasibility of near-infrared spectroscopy (NIRS) for the detection of delayed cerebral ischemia (DCI) in patients with poor-grade subarachnoid hemorrhage (SAH) treated with coil embolization. Methods Cerebral regional oxygen saturation (rSO 2 ) was continuously monitored via two-channel NIRS for 14 days following SAH. The rSO 2 levels according to DCI were analyzed by using the Mann–Whitney U -test. A receiver operating characteristic curve was generated on the basis of changes in rSO 2 by using the rSO 2 level on day 1 as a reference value to determine the optimal cutoff value for identifying DCI. Results Twenty-four patients with poor-grade SAH were included (DCI, n = 8 [33.3%]; non-DCI, n = 16 [66.7%]). The rSO 2 levels of patients with DCI were significantly lowered from 6 to 9 days compared with those in without DCI. The rSO 2 level was 62.55% (58.30–63.40%) on day 6 in patients with DCI versus 65.40% (60.90–68.70%) in those without DCI. By day 7, it was 60.40% (58.10–61.90%) in patients with DCI versus 64.25% (62.50–67.10%) those without DCI. By day 8, it was 58.90% (56.50–63.10%) in patients with DCI versus 66.05% (59.90–69.20%) in those without DCI, and by day 9, it was 60.85% (58.40–65.20%) in patients with DCI versus 65.80% (62.70–68.30%) in those without DCI. A decline of greater than 14.5% in the rSO 2 rate yielded a sensitivity of 92.86% (95% confidence interval: 66.1–99.8%) and a specificity of 88.24% (95% confidence interval: 72.5–96.7%) for identifying DCI. A decrease by more than 14.7% of the rSO 2 level indicates a sensitivity of 85.7% and a specificity of 85.7% for identifying DCI. Conclusions Near-infrared spectroscopy shows some promising results for the detection of DCI in patients with poor-grade SAH. Further studies involving a large cohort of the SAH population are required to confirm our results. Supplementary Information The online version contains supplementary material available at 10.1007/s12028-021-01223-2.

Association of Haptoglobin Phenotype With Neurological and Cognitive Outcomes in Patients With Subarachnoid Hemorrhage

“…In general, continuous lumbar drainage was maintained until 7 days after the treatment. Nimodipine (Samjin Pharmaceutical, Seoul, South Korea) was administered intravenously at a dose of 20 μg/kg/h to prevent cerebral vasospasm ( Park et al, 2021 ).…”

“…The H-H grade was divided into two groups: lower H-H (I, II, and III) and higher H-H group (IV and V), and likewise Fisher grade was divided into a low grade (Fisher grades I and II) and high grade (Fisher grades III and IV) ( Kim et al, 2018 ). Severe cerebral vasospasm was defined as a decrease in vessel diameter of over 70% compared with baseline computed tomography angiography or magnetic resonance angiography ( Park et al, 2021 ). This study was approved by the Institutional Review Boards (IRB No: 2016-31, 2018-6, and 2019-06).…”

Multimodality Monitoring for Delayed Cerebral Ischemia in Subarachnoid Hemorrhage: A Mini Review

“…Although mainly used as an intraoperative monitoring tool in cardiac surgery, near-infrared spectroscopy (NIRS) has gained increasing awareness as a non-invasive modality option within the intensive care unit ( 50 , 51 ). The modality can display regional cerebral oxygen saturation (rSO2) in the frontal lobes and has previously been validated in stroke patients to correlate with cerebral blood flow through perfusion imaging ( 52 ).…”

Near Infrared Spectroscopy for Poor Grade Aneurysmal Subarachnoid Hemorrhage—A Concise Review

“…More interestingly, the same 12% cut-off yielded a sensitivity of 94% (95% CI: 73–99%) and a specificity of 71% (95% CI: 53–85%) to detect DCI ( 59 ). Another study on 24 patients presenting with poor grade aSAH reported a sensitivity of 86% (95% CI: 67–98%) and specificity of 86% (95% CI: 67–96%) for DCI detection using a greater than 15% decrease in c-rSO 2 ( 60 ).…”