Background. Goal-directed fluid therapy reduces morbidity and mortality in various clinical settings. Respiratory variations in photoplethysmography are proposed as a noninvasive alternative to predict fluid responsiveness during mechanical ventilation. This paper aims to critically evaluate current data on the ability of photoplethysmography to predict fluid responsiveness. Method. Primary searches were performed in PubMed, Medline, and Embase on November 10, 2011. Results. 14 papers evaluating photoplethysmography and fluid responsiveness were found. Nine studies calculated areas under the receiver operating characteristic curves for POP (>0.85 in four, 0.75–0.85 in one, and <0.75 in four studies) and seven for PVI (values ranging from 0.54 to 0.98). Correlations between POP/PVI and PP/other dynamic variables vary substantially. Conclusion. Although photoplethysmography is a promising technique, predictive values and correlations with other hemodynamic variables indicating fluid responsiveness vary substantially. Presently, it is not documented that photoplethysmography is adequately valid and reliable to be included in clinical practice for evaluation of fluid responsiveness. 1. Introduction Whether or not to administer intravenous (iv) fluid is a common, difficult, and controversial challenge in clinical practice. The main aim of fluid therapy during surgery or critical illness is to provide adequate tissue perfusion by increasing stroke volume (SV) or cardiac output (CO). Goal-directed fluid therapy aiming to increase oxygen (O2) delivery reduces morbidity and mortality in various clinical settings [1–8]. Fluid therapy is guided by clinical variables, as well as static and dynamic variables. Clinical variables include blood pressure, heart rate, capillary refill time, skin turgor and diuresis, mixed venous oxygen saturation (SvO2), lactate, pH, electrolytes, and creatinine/urea. Conventional static variables include central venous pressure (CVP) and pulmonary artery wedge pressure (PAWP), but these variables have proven less reliable than initially assumed to evaluate fluid responsiveness [8–10]. Dynamic variables include both SV-dependent and non-SV-dependent methods. The ideal new method should be accurate [11], easy to use, noninvasive, and widely available with minimal risk of complications. Potential clinical value also depends on reproducibility and predictive values compared to established methods. Photoplethysmography (more specifically pulse oximetry plethysmographic waveform analysis) as a noninvasive tool in evaluation of fluid
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