Cerebral near-infrared spectroscopy monitoring (NIRS) in children and adults: a systematic review with meta-analysis
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Published:2022-02-22
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ISSN:0031-3998
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Container-title:Pediatric Research
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language:en
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Short-container-title:Pediatr Res
Author:
Hansen Mathias LührORCID, Hyttel-Sørensen Simon, Jakobsen Janus Christian, Gluud Christian, Kooi Elisabeth M. W., Mintzer Jonathan, de Boode Willem P., Fumagalli Monica, Alarcon Ana, Alderliesten Thomas, Greisen Gorm, Austin Topun, Bruckner Marlies, de Boode Willem P., Dempsey Eugene, Ergenekon Ebru, Gucuyener Kivilcim, Levy Philip T., Liem Kian D., Martini Silvia, Naulaers Gunnar, Neunhoeffer Felix, Pellicer Adelina, Pichler Gerhard, Roehr Charles Christoph, Roll Claudia, Schwarz Christoph E., Szczapa Tomasz, Urlesberger Berndt, Wolf Martin, Wong Flora, Rhee Christopher J., Lemmers Petra,
Abstract
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; I2 = 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; I2 = 39.6; 9 trials; very low certainty of evidence); and serious adverse events (RR 0.82; 95% CI 0.67–1.01; 2132 participants; I2 = 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.
Publisher
Springer Science and Business Media LLC
Subject
Pediatrics, Perinatology and Child Health
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