Correction: Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review

(2025) 15:21 Pfortmueller et al. Annals of Intensive Care https://doi.org/10.1186/s13613-024-01403-1 Annals of Intensive Care Open Access CORRECTION Correction: Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment—a comprehensive review Carmen Andrea Pfortmueller1* , Wojciech Dabrowski2, Rob Wise3,4,5, Niels van Regenmortel6,7 and Manu L. N. G. Malbrain2,8,9 Correction: Annals of Intensive Care (2024) 14:115 https://doi.org/10.1186/s13613-024-01336-9 Following publication of the original article, the authors removed the word “prevention” in Table 1 as it is already in the table title and the title of Table 2 has been corrected. Table 3 has been edited. The corrected tables 1, 2 and 3 are given below. The authors identified an error in Figs. 1, 2 and 3. Figure 1 has now been replaced by a Textbox 1 on the critical appraisal of the definition for fluid accumulation syndrome. Figure 2 then became Figure 1 and Figure 3 became a modified Figure 2. The corrected figures are given below as well as the textbox. The original article can be found online at https://doi.org/10.1186/s13613- 024-01336-9. *Correspondence: Carmen Andrea Pfortmueller 1 Department of Intensive Care, Inselspital, Bern University Hospital and University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland 2 First Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin, Lublin, Poland 3 Department of Anaesthesia and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa 4 Faculty Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium 5 Intensive Care Department, John Radcliffe Hospital, Oxford University Trust Hospitals, Oxford, UK 6 Department of Intensive Care Medicine, Ziekenhuis Netwerk Antwerpen Campus Stuivenberg/Cadix, Antwerp, Belgium 7 Department of Intensive Care Medicine, Antwerp University Hospital, Antwerp, Belgium 8 International Fluid Academy, Lovenjoel, Belgium 9 Medical Data Management, Medaman, Geel, Belgium © The Author(s) 2025. 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Annals of Intensive Care (2025) 15:21 Page 2 of 7 Table 1 Prevention and monitoring of fluid accumulation syndrome (FAS) NOTE: Fluids should only be administrated when hypovolemia, fluid responsiveness AND signs of impaired tissue perfusion are present Monitoring – Basic monitoring (i.e. arterial and central venous line), – in case of unresolved shock consider echocardiography and advanced hemodynamic monitoring (eg. pulse contour or transpulmonary thermodilution) – obtain baseline body weight (scale, estimate, retrieve from medical records) – Monitor for risk for fluid accumulation: i.e. daily body weight, daily and cumulative fluid balance, edema formation, sonography – Assess for impaired end-organ function: IAP, APP, PF ratio, success of EN, EVLWI, PVPI, BIA – Assess fluid responsiveness with functional hemodynamics (i.e. PPV or SVV, passive leg raising test, end-expiratory occlusion test) – Assess for signs of tissue hypoperfusion (DO2/VO2 mismatch; i.e. elevated lactate, increased mottling score, increased capillary refill time) Prevention A) Fluids are required – use a restrictive fluid management regime – when maintenance fluids are necessary, opt for balanced and sodium-poor alternatives (NaCl 0.18–0.45%) – Use low-chloride alternatives to NaCl 0.9% when selecting resuscitation and replacement fluids – frequently re-assess preload and fluid responsiveness/tissue perfusion, only administer fluids in fluid responsive patients – consider early norepinephrine use – stop fluid administration once fluid responsiveness and/or tissue perfusion are absent – consider the (early) use of albumin 20%, especially when serum albumin levels are low (< 30g/L) [1] B) Fluids are not required: de-escalation – Limit fluid intake – Limit sodium intake – Limit/avoid maintenance solutions – Limit/avoid fluid creep – Improve lymphatic drainage (i.e. use leg compression bandages) – Use high density or concentrated enteral formula’s (i.e. 2 kcal/ml) Table adapted with permission from Malbrain et al. according to the Open Access CC BY Licence 4.0 (ESM file) [2] This table presents some suggestions for prevention of fluid accumulation based on personal experience of the co-authors. It does not aim to provide an exhaustive, graded and concise overview of the literature as current evidence is mostly limited to observational, retrospective or small clinical studies, and more randomized trials are needed to better establish a personalized approach to fluid management. For more information we refer the reader to some recent review papers on this topic [3, 4] EN: enteral nutrition, EVLWI: extra-vascular lung water index, FA: fluid accumulation, APP: abdominal perfusion pressure (MAP minus IAP), IAP: intra-abdominal pressure, PEEP: positive end-expiratory pressure, PF: PaO2 over FiO2 ratio, PPV: pulse pressure variation, CVVH: continuous veno-venous hemofiltration, IAP: intraabdominal pressure, MAP: mean arterial pressure, PPV: pulse pressure variation, RRT: renal replacement therapy, SVV: stroke volume variation, UF: ultrafiltration, BIA: bio-electrical impedance analysis Table 2 Terminology Resuscitation fluids Resuscitation fluids refer to the fluids administrated in the early initial phase of shock to restore of adequate organ perfusion. They should only be given in case of shock (DO2/VO2 imbalance with increased lactate) AND low preload AND fluid responsiveness and they should always be given as a fluid challenge i.e. assessing fluid status and fluid responsiveness before and after. Most often they are given as a bolus of 4ml/kg over 10–15 min [5] Fluid Creep A term that refers to the unintentional and unmeasured fluid volumes administered in the process of delivering other medication (antibiotics, sedatives, painkillers, etc.) and/or nutrition through enteral and parenteral route (...truncated)