{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T01:57:43Z","timestamp":1785895063867,"version":"3.56.0"},"reference-count":57,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T00:00:00Z","timestamp":1757376000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Anaesthesiol Scand"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Sepsis remains a leading cause of mortality, with mortality from septic shock exceeding 40%. Standardized resuscitation (30\u2009mL\/kg) may cause adverse outcomes, including fluid overload or prolonged hypotension, emphasizing the need for individualized strategies. Sepsis\u2010induced shock arises from varying degrees of vasodilation and hypovolemia, yet patients often present with similar clinical signs in the emergency department (ED). Photoplethysmography (PPG), a non\u2010invasive technique reflecting peripheral perfusion, may help identify patients with a predominant vasodilatory profile who could benefit from early vasopressor therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This post hoc analysis used data from the Acutelines biobank at the University Medical Centre Groningen. Adults admitted for non\u2010trauma specialties with suspected infection and hemodynamic instability (MAP\u2009&lt;\u200970\u2009mmHg, SBP\u2009&lt;\u200990\u2009mmHg, shock index &gt;\u20090.9, or lactate &gt;\u20094.0\u2009mmol\/L) were included. PPG data were pre\u2010processed and features extracted. Principal component analysis (PCA) and K\u2010means clustering enabled dimensionality reduction and hemodynamic profiling. Logistic regression assessed the discriminative performance of PPG\u2010based models for vasopressor therapy initiation within 24\u2009h.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 325 patients, 16.3% received vasopressors. PCA identified three principal components explaining 80.3% of variance: PC1 (arterial compliance), PC2 (cardiac output and systemic vascular resistance), and PC3 (peripheral vasomotor tone). The PPG\u2010based model showed moderate discriminative power (AUROC: 0.75), improving when combined with MAP and lactate (AUROC: 0.83).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>PPG enables identification of patients likely to benefit from vasopressor therapy during the first 20\u2009min after ED arrival. By providing additional insight into peripheral perfusion, this proof\u2010of\u2010principle study supports further exploration of PPG as a clinical support tool for personalized hemodynamic resuscitation in sepsis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Editorial Comment<\/jats:title><jats:p>This secondary analysis demonstrates early peripheral circulatory patterns in sepsis using photoplethysmography at the start of resuscitation. Distinct PPG\u2010derived profiles were associated with vasopressor initiation within 24\u2009h, supporting PPG as a tool for personalized resuscitation.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aas.70119","type":"journal-article","created":{"date-parts":[[2025,9,9]],"date-time":"2025-09-09T09:57:42Z","timestamp":1757411862000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Novel Approach to Early Personalized Hemodynamic Resuscitation: Non\u2010Invasive Peripheral Photoplethysmography for Identifying Predominant Vasodilatory Shock in Sepsis"],"prefix":"10.1111","volume":"69","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9855-2919","authenticated-orcid":false,"given":"Sanne","family":"Ter Horst","sequence":"first","affiliation":[{"name":"Department of Internal Medicine University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna D.","family":"Schoonhoven","sequence":"additional","affiliation":[{"name":"Department of Acute Care University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond J.","family":"van Wijk","sequence":"additional","affiliation":[{"name":"Department of Acute Care University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rick","family":"Weitering","sequence":"additional","affiliation":[{"name":"Department of Acute Care University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanne W.","family":"van Loon","sequence":"additional","affiliation":[{"name":"Department of Acute Care University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan C.","family":"ter Maaten","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Groningen, University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Acute Care University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hjalmar R.","family":"Bouma","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine University of Groningen, University Medical Center Groningen  Groningen the Netherlands"},{"name":"Department of Clinical Pharmacy and Pharmacology University of Groningen, University Medical Center Groningen  Groningen the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,9,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1089\/sur.2017.278"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2403213"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)32989-7"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06506-y"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.0287"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/imj.14199"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2016.12.004"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066618784861"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2020.04.025"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-024-04834-1"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2016.12310"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/SHK.0000000000000268"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e3181feeb15"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000004617"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-024-01336-9"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201806-1034OC"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-020-2756-3"},{"key":"e_1_2_11_19_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12093188"},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0000000000000507"},{"key":"e_1_2_11_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2017.08.005"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13054-022-03911-7"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCE.0000000000001274"},{"issue":"45","key":"e_1_2_11_24_1","first-page":"757","article-title":"Nomenklatur, Definition and Differenzierung der Schockformen","volume":"115","author":"Standl T.","year":"2018","journal-title":"Deutsches \u00c4rzteblatt International"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.21037\/atm.2020.04.24"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2025.155115"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1088\/0967-3334\/28\/3\/R01"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.3389\/fphys.2021.808451"},{"key":"e_1_2_11_29_1","doi-asserted-by":"publisher","DOI":"10.2174\/157340312801215782"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-047349"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.3390\/bioengineering3040021"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11517-010-0713-z"},{"key":"e_1_2_11_34_1","doi-asserted-by":"publisher","DOI":"10.1109\/JSEN.2019.2961411"},{"key":"e_1_2_11_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.accpm.2021.100964"},{"key":"e_1_2_11_36_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc7159"},{"key":"e_1_2_11_37_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13613-019-0511-1"},{"key":"e_1_2_11_38_1","first-page":"5507","article-title":"Photoplethysmographic Variability Analysis in Critical Care Current Progress and Future Challenges","author":"Chan G. S. H.","year":"2011","journal-title":"Proceedings of the Annual International Conference of the IEEE Engineering in Medicine and Biology Society EMBS"},{"key":"e_1_2_11_39_1","doi-asserted-by":"publisher","DOI":"10.5935\/0103-507X.20220004-en"},{"key":"e_1_2_11_40_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc8167"},{"key":"e_1_2_11_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-021-06595-9"},{"key":"e_1_2_11_42_1","doi-asserted-by":"publisher","DOI":"10.15441\/ceem.22.324"},{"key":"e_1_2_11_43_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201905-0968OC"},{"key":"e_1_2_11_44_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2019.0071"},{"key":"e_1_2_11_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066620982585"},{"key":"e_1_2_11_46_1","doi-asserted-by":"publisher","DOI":"10.1007\/s13755-022-00199-3"},{"key":"e_1_2_11_47_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-020-74686-6"},{"key":"e_1_2_11_48_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(23)00087-0"},{"key":"e_1_2_11_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2024.111605"},{"key":"e_1_2_11_50_1","doi-asserted-by":"publisher","DOI":"10.3390\/s24196379"},{"key":"e_1_2_11_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2025.01.007"},{"key":"e_1_2_11_52_1","doi-asserted-by":"publisher","DOI":"10.1109\/EMBC48229.2022.9871741"},{"key":"e_1_2_11_53_1","doi-asserted-by":"publisher","DOI":"10.3390\/s23156736"},{"key":"e_1_2_11_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2589-7500(22)00194-7"},{"key":"e_1_2_11_55_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41581-019-0199-3"},{"key":"e_1_2_11_56_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41390-021-01620-5"},{"key":"e_1_2_11_57_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00540-021-02908-w"},{"key":"e_1_2_11_58_1","doi-asserted-by":"publisher","DOI":"10.1177\/08850666231187333"}],"container-title":["Acta Anaesthesiologica Scandinavica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/aas.70119","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,27]],"date-time":"2025-09-27T06:22:51Z","timestamp":1758954171000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/aas.70119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9,9]]},"references-count":57,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2025,10]]}},"alternative-id":["10.1111\/aas.70119"],"URL":"https:\/\/doi.org\/10.1111\/aas.70119","archive":["Portico"],"relation":{},"ISSN":["0001-5172","1399-6576"],"issn-type":[{"value":"0001-5172","type":"print"},{"value":"1399-6576","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9,9]]},"assertion":[{"value":"2025-04-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-29","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-09-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70119"}}