Cerebral near-infrared spectroscopy monitoring (NIRS) in children and adults: a systematic review with meta-analysis
Year: 2022
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Cerebral oxygenation monitoring utilising near-infrared spectroscopy (NIRS) is increasingly used to guide interventions in clinical care. The objective of this systematic review with meta-analysis and Trial Sequential Analysis is to evaluate the effects of clinical care with access to cerebral NIRS monitoring in children and adults versus care without. Methods This review conforms to PRISMA guidelines and was registered in PROSPERO (CRD42020202986). Methods are outlined in our protocol (doi: 10.1186/s13643-021-01660-2). Results Twenty-five randomised clinical trials were included (2606 participants). All trials were at a high risk of bias. Two trials assessed the effects of NIRS during neonatal intensive care, 13 during cardiac surgery, 9 during non-cardiac surgery and 1 during neurocritical care. Meta-analyses showed no significant difference for all-cause mortality (RR 0.75, 95% CI 0.51–1.10; 1489 participants; I 2 = 0; 11 trials; very low certainty of evidence); moderate or severe, persistent cognitive or neurological deficit (RR 0.74, 95% CI 0.42–1.32; 1135 participants; I 2 = 39.6; 9 trials; very low certainty of evidence); and serious adverse events (RR 0.82; 95% CI 0.67–1.01; 2132 participants; I 2 = 68.4; 17 trials; very low certainty of evidence). Conclusion The evidence on the effects of clinical care with access to cerebral NIRS monitoring is very uncertain. Impact The evidence of the effects of cerebral NIRS versus no NIRS monitoring are very uncertain for mortality, neuroprotection, and serious adverse events. Additional trials to obtain sufficient information size, focusing on lowering bias risk, are required. The first attempt to systematically review randomised clinical trials with meta-analysis to evaluate the effects of cerebral NIRS monitoring by pooling data across various clinical settings. Despite pooling data across clinical settings, study interpretation was not substantially impacted by heterogeneity. We have insufficient evidence to support or reject the clinical use of cerebral NIRS monitoring.
Source: Pediatric Research
Authors: Mathias Lühr Hansen, Simon Hyttel-Sørensen, Janus Christian Jakobsen, Christian Gluud, Elisabeth M. W. Kooi, Jonathan Mintzer, Willem P. de Boode, Monica Fumagalli, Ana Alarcon, Thomas Alderliesten, Gorm Greisen, Topun Austin, Marlies Bruckner, Willem P. de Boode, Eugene Dempsey, Ebru Ergenekon, Kivilcim Gucuyener, Philip T. Levy, Kian D. Liem, Silvia Martini, Gunnar Naulaers, Felix Neunhoeffer, Adelina Pellicer, Gerhard Pichler, Charles Christoph Roehr, Claudia Roll, Christoph E. Schwarz, Tomasz Szczapa, Berndt Urlesberger, Martin Wolf, Flora Wong, Christopher J. Rhee, Petra Lemmers
Institutions: Copenhagen University Hospital, Rigshospitalet, University of Southern Denmark, University Medical Center Groningen, University of Groningen, Beatrix Kinderziekenhuis, Hackensack University Medical Center Mountainside, Radboud University Medical Center, Amalia Kinderziekenhuis, Radboud Institute for Health Sciences, University of Milan, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Hospital Sant Joan de Déu Barcelona, Utrecht University, University Medical Center Utrecht, Cambridge University Hospitals NHS Foundation Trust, Medical University of Graz, University College Cork, Infant, Gazi Hastanesi, Boston Children's Hospital, Harvard University, IRCCS Azienda Ospedliero-Universitaria di Bologna Policlinico di Sant'Orsola, University of Bologna, KU Leuven, University Children's Hospital Tübingen, University of Tübingen, Hospital Universitario La Paz, North Bristol NHS Trust, Southmead Hospital, University of Bristol, University of Oxford, Witten/Herdecke University, Poznan University of Medical Sciences, University Hospital Zurich, Hudson Institute of Medical Research, Monash Children’s Hospital, Monash University, Baylor College of Medicine, Texas Children's Hospital, Wilhelmina Children's Hospital
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
Funders: Texas Children's Hospital, Harvard University, Health Research Board, University of Cambridge, University of Oxford, University of Bristol, University College Cork, Monash University, Radboud Universiteit, Cambridge University Hospitals, Gazi Üniversitesi, KU Leuven, Università di Bologna, Radboud Universitair Medisch Centrum, Elsass Fonden, European Society for Paediatric Research, Karl-Franzens-Universität Graz, Universitätsspital Zürich, Medizinische Universität Graz, Aage og Johanne Louis-Hansens Fond, Uniwersytet Medyczny im. Karola Marcinkowskiego w Poznaniu, Hudson Institute of Medical Research, Radboud Institute for Health Sciences
Awards: G1994447290, G9000370833
OpenAlex ID: W4213073304