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עברית
Carmen Andrea Pfortmueller1* , Wojciech Dabrowski2 , Rob Wise3,4,5, Niels van Regenmortel6,7 and Manu L. N. G. Malbrain2,8,9
Abstract 
In this review, we aimed to comprehensively summarize current literature on pathophysiology, relevance, diagnosis and treatment of fuid accumulation in patients with sepsis/septic shock. Fluid accumulation syndrome (FAS) is defned as fuid 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 fuid intake (e.g., by limiting intravenous fuid administration and employing de-escalation whenever possible), limiting sodium and chloride administration, and maximizing fuid 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 fuid management regime with a standardized early active de-resuscitation, maintenance fuid reduction (avoiding fuid creep) and potentially using physical measures such as compression stockings. Trial registration: Not applicable. Keywords Fluids, Resuscitation, De-resuscitation, Fluid accumulation, Safety, Monitoring
