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Resting-State NIRS-EEG in Unresponsive Patients with Acute Brain Injury: A Proof-of-Concept Study

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BACKGROUND: Neurovascular-based imaging techniques such as functional MRI (fMRI) may reveal signs of consciousness in clinically unresponsive patients but are often subject to logistical challenges in the intensive care unit (ICU). Near-infrared spectroscopy (NIRS) is another neurovascular imaging technique but low cost, can be performed serially at the bedside, and may be combined with electroencephalography (EEG), which are important advantages compared to fMRI. Combined NIRS-EEG, however, has never been evaluated for the assessment of neurovascular coupling and consciousness in acute brain injury.

METHODS: We explored resting-state oscillations in eight-channel NIRS oxyhemoglobin and eight-channel EEG band-power signals to assess neurovascular coupling, the prerequisite for neurovascular-based imaging detection of consciousness, in patients with acute brain injury in the ICU (n = 9). Conscious neurological patients from step-down units and wards served as controls (n = 14). Unsupervised adaptive mixture-independent component analysis (AMICA) was used to correlate NIRS-EEG data with levels of consciousness and clinical outcome.

RESULTS: Neurovascular coupling between NIRS oxyhemoglobin (0.07-0.13 Hz) and EEG band-power (1-12 Hz) signals at frontal areas was sensitive and prognostic to changing consciousness levels. AMICA revealed a mixture of five models from EEG data, with the relative probabilities of these models reflecting levels of consciousness over multiple days, although the accuracy was less than 85%. However, when combined with two channels of bilateral frontal neurovascular coupling, weighted k-nearest neighbor classification of AMICA probabilities distinguished unresponsive patients from conscious controls with > 90% accuracy (positive predictive value 93%, false discovery rate 7%) and, additionally, identified patients who subsequently failed to recover consciousness with > 99% accuracy.

DISCUSSION: We suggest that NIRS-EEG for monitoring of acute brain injury in the ICU is worthy of further exploration. Normalization of neurovascular coupling may herald recovery of consciousness after acute brain injury.

TidsskriftNeurocritical Care
Udgave nummer1
Sider (fra-til)31-44
Antal sider14
StatusUdgivet - feb. 2021

Bibliografisk note

Funding Information:
This work was supported by the Lundbeck Foundation (MW, DK), Offerfonden (DK), Savværksejer Jeppe Juhl og Hustru Ovita Juhls Mindelegat (DK), Region Hovedstadens Forskningsfond til Sundhedsforskning (DK), Jaschafonden (DK), Rigshospitalets Forskningspulje (DK), and NovoNordisk Foundation NNF17OC0028706 (JK, JG, and SK). AD and MB were supported by the University at Buffalo, USA. Figures 1 and 2 are created with

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