Near Infrared Spectroscopy for High-Temporal Resolution Cerebral Physiome Characterization in TBI: A Narrative Review of Techniques, Applications, and Future Directions

Abstract

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.

Non-Invasive and Minimally-Invasive Cerebral Autoregulation Assessment: A Narrative Review of Techniques and Implications for Clinical Research

“…Future work may improve the spatial resolution of the continuous modalities by measuring hemispheric CA using TCD or NIRS. Beyond this, the development of full scalp NIRS arrays, like those seen in fNIRS, may bring the spatial resolution of these continuous modulates inline with image-based intermittent methods ( 77 ).…”

The Quantitative Associations Between Near Infrared Spectroscopic Cerebrovascular Metrics and Cerebral Blood Flow: A Scoping Review of the Human and Animal Literature

“…This included CW-NIRS, FR-NIRS, TR-NIRS, and DCE-NIRS as well as DCS. A full description of these methodologies can be found in a previous review by this group (Gomez et al, 2021c). "Widely accepted" measures of CBF included the following:…”

“…Distinct from other modalities, DCE-NIRS requires the use of an exogenous contrast agent and application of the Fick principle (Gomez et al, 2021c). In all of the articles that leveraged this modality, indocyanine green (ICG) was utilized as the contrast agent (Kuebler et al, 1998;Roberts et al, 1998;Brown et al, 2001Brown et al, , 2002De Visscher et al, 2003;Keller et al, 2003;Rothoerl et al, 2003;Schytz et al, 2009;Elliott et al, 2010Elliott et al, , 2014Saito et al, 2018;Milej et al, 2020).…”

Transcranial near-infrared light in treatment of neurodegenerative diseases

“…The emitted light can penetrate transcranially the physical barriers of the skin and skull and reach the brain parenchyma if an optical window is used between 650 nm and 1,200 nm without excessive heat generation. Biomedical reports demonstrate the ability of NIR light to stimulate biochemical processes that maintain a healthy brain state and can be beneficial in acute and chronic pathologic brain conditions ( Enengl et al, 2020 ), ( Sanderson et al, 2018 ), ( Gomez et al, 2021 ), ( Li et al, 2022 ). Recent reports shed more light on different biological and chemical features of NIR light and its potential in treating disease states, prompting further research in this area.…”