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Monitoring the injured brain to detect and treat harmful events that can cause secondary injury during the acute recovery period is a central part of neurointensive care. The most basic monitoring tool is the neurological examination, such as the Glasgow Coma Score; however, a large component of this scale involves verbal communication and braininjured patents are often comatose, mechanically ventilated or sedated. As well, symptoms of neurological deterioration detected by examination often occur at late stages of brain injury. Since the brain is extremely vulnerable to ischemia, a more direct indicator of potential brain injury is detecting impaired cerebral blood flow (CBF). Multiple factors following brain injury can cause ischemia, including systemic hypotension, cerebral hemorrhage, and edema – all of which independently worsen survival (Helmy et al., 2007). This focus has lead to the recognition that continuous monitoring of CBF in patients with, or at risk of, brain injury could improve outcome by providing the ability to detect and prevent cerebral ischemia. Imaging techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT), are critical to the management of brain-injured patients as they provide detailed structural and functional information of the brain when patients are admitted to an emergency department (Gallagher et al., 2007). CT is the modality of choice because it is widely available and examination times are relatively short. Furthermore, techniques for measuring CBF have been developed on these imaging modalities (Wintermark et al., 2005) and subsequently used to identify CBF abnormalities following brain injury (DeWitt & Prough, 2003; Gowda et al., 2006; Soustiel et al., 2008). Despite these promising advances, conventional imaging modalities suffer from serious disadvantages regarding cerebral monitoring. First, they require transferring patients to imaging facilities which represents a significant risk factor when dealing with critically ill patients. Second, they only provide a single time-point measurement and, therefore, suffer from the possibility of missing flow abnormalities that occur at different times during intensive care. Clearly, effective cerebral monitoring requires bedside techniques.

Towards Non-Invasive Bedside Monitoring of Cerebral Blood Flow and Oxygen Metabolism in Brain-Injured Patients with Near-Infrared Spectroscopy