Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review
Abstract In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage...
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| Format: | Article |
| Language: | English |
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SpringerOpen
2024-07-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-024-01336-9 |
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| author | Carmen Andrea Pfortmueller Wojciech Dabrowski Rob Wise Niels van Regenmortel Manu L. N. G. Malbrain |
| author_facet | Carmen Andrea Pfortmueller Wojciech Dabrowski Rob Wise Niels van Regenmortel Manu L. N. G. Malbrain |
| author_sort | Carmen Andrea Pfortmueller |
| collection | DOAJ |
| description | Abstract In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage from baseline body weight) with new onset organ-failure. Over the years, many studies have described the negative impact of FAS on clinically relevant outcomes. While the relationship between FAS and ICU outcomes is well described, uncertainty exists regarding its diagnosis, monitoring and treatment. A stepwise approach is suggested to prevent and treat FAS in patients with septic shock, including minimizing fluid intake (e.g., by limiting intravenous fluid administration and employing de-escalation whenever possible), limiting sodium and chloride administration, and maximizing fluid output (e.g., with diuretics, or renal replacement therapy). Current literature implies the need for a multi-tier, multi-modal approach to de-resuscitation, combining a restrictive fluid management regime with a standardized early active de-resuscitation, maintenance fluid reduction (avoiding fluid creep) and potentially using physical measures such as compression stockings. Trial registration: Not applicable. Graphical Abstract |
| format | Article |
| id | doaj-art-8a526929628b423d8d1f2018b8cf2180 |
| institution | Kabale University |
| issn | 2110-5820 |
| language | English |
| publishDate | 2024-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Annals of Intensive Care |
| spelling | doaj-art-8a526929628b423d8d1f2018b8cf21802025-02-02T12:42:27ZengSpringerOpenAnnals of Intensive Care2110-58202024-07-0114111210.1186/s13613-024-01336-9Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive reviewCarmen Andrea Pfortmueller0Wojciech Dabrowski1Rob Wise2Niels van Regenmortel3Manu L. N. G. Malbrain4Department of Intensive Care, Inselspital, Bern University Hospital and University of BernFirst Department of Anaesthesiology and Intensive Therapy, Medical University of LublinDepartment of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-NatalDepartment of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg/CadixFirst Department of Anaesthesiology and Intensive Therapy, Medical University of LublinAbstract In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fluid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defined as fluid accumulation (any degree, expressed as percentage from baseline body weight) with new onset organ-failure. Over the years, many studies have described the negative impact of FAS on clinically relevant outcomes. While the relationship between FAS and ICU outcomes is well described, uncertainty exists regarding its diagnosis, monitoring and treatment. A stepwise approach is suggested to prevent and treat FAS in patients with septic shock, including minimizing fluid intake (e.g., by limiting intravenous fluid administration and employing de-escalation whenever possible), limiting sodium and chloride administration, and maximizing fluid output (e.g., with diuretics, or renal replacement therapy). Current literature implies the need for a multi-tier, multi-modal approach to de-resuscitation, combining a restrictive fluid management regime with a standardized early active de-resuscitation, maintenance fluid reduction (avoiding fluid creep) and potentially using physical measures such as compression stockings. Trial registration: Not applicable. Graphical Abstracthttps://doi.org/10.1186/s13613-024-01336-9FluidsResuscitationDe-resuscitationFluid accumulationSafetyMonitoring |
| spellingShingle | Carmen Andrea Pfortmueller Wojciech Dabrowski Rob Wise Niels van Regenmortel Manu L. N. G. Malbrain Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review Annals of Intensive Care Fluids Resuscitation De-resuscitation Fluid accumulation Safety Monitoring |
| title | Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review |
| title_full | Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review |
| title_fullStr | Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review |
| title_full_unstemmed | Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review |
| title_short | Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review |
| title_sort | fluid accumulation syndrome in sepsis and septic shock pathophysiology relevance and treatment a comprehensive review |
| topic | Fluids Resuscitation De-resuscitation Fluid accumulation Safety Monitoring |
| url | https://doi.org/10.1186/s13613-024-01336-9 |
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