Use of near-infrared spectroscopy to guide care in the pediatric cardiac ICU: just another glorified gadget?

PURPOSE OF REVIEW: Near-infrared spectroscopy (NIRS) is increasingly used in pediatric cardiac intensive care to monitor regional tissue oxygenation. Despite its widespread adoption, its clinical utility remains uncertain. This review examines the physiological rationale, accuracy, potential benefits, and limitations of NIRS as a monitoring tool in critically ill children, emphasizing whether it improves outcomes or meaningfully guides management. RECENT FINDINGS: NIRS provides continuous, noninvasive regional oxygenation data, but measurements are affected by technical and physiological confounders and correlate only moderately with validated markers of systemic perfusion. Although low values may prompt interventions, no randomized trials have demonstrated improved mortality, neurological outcomes, or organ function with NIRS-guided care. Thresholds for intervention vary widely, and most centers lack standardized response protocols. NIRS use may increase unnecessary interventions, contribute to alarm fatigue, and impose substantial financial costs without demonstrated benefit. SUMMARY: Current evidence suggests that NIRS should serve as an adjunct rather than a primary driver of clinical decision-making in pediatric cardiac intensive care. Established modalities such as venous oxygen saturation, lactate trends, echocardiography, and functional hemodynamic assessments provide more actionable information. Further trials are required to define whether NIRS improves outcomes.