We investigate how fluid overload and fluid Accumulation Syndrome in critically ill patients can be prevented and actively de-escalated, which infusion solutions benefit which patient groups, and how biomarkers and AI can improve diagnostics and prognosis in intensive care medicine.

Fluid Accumulation Syndrome & De-Escalation
Pathophysiology, diagnosis and active treatment of fluid accumulation in sepsis and septic shock — incl. ESICM guideline development

Electrolyte & Acid-Base Disorders
Clinical relevance of chloride and other electrolyte disorders and their relationship with infusion therapy in critically ill patients

Biomarkers & Prognostic Scores
Evaluation of patient-adjusted D-dimer cut-off values for the diagnosis of venous thromboembolism in critically ill patients

Infusion Therapy & Fluid Choice
Patient-centred choice of infusion solutions and their effect on organ and neurological function

Acute Kidney Injury & Long-Term Renal Outcomes
Impact of fluid accumulation on renal outcomes, long-term mortality after AKI, and prevention of perioperative kidney injury

Data Infrastructure & AI in Intensive Care Medicine
Development of reusable ICU datasets and automated research infrastructure for AI-powered early warning systems and clinical decision support

Fluid therapy is one of the most frequent interventions in intensive care medicine — and one of the most underestimated risks. We investigate the entire course of infusion therapy: from the choice of infusion solution through the early detection of fluid overload to active de-escalation via targeted diuretic therapy. We conceptually distinguish between the targeted choice of crystalloid (effects on organ function, electrolyte and acid-base balance), the management of creep and maintenance fluids as an often-overlooked source of cumulative sodium and fluid intake, and active de-escalation — the deliberate removal of excess fluid in patients with Fluid Accumulation Syndrome.

We additionally evaluate new diagnostic approaches — from non-invasive pressure measurements using electrical impedance tomography to ultrasound scores for assessing readiness for fluid de-escalation. A further focus is the development of a sustainable data infrastructure for automated clinical research and AI: we build reusable ICU datasets and analysis pipelines as a foundation for early warning systems and data-driven phenotyping.

“CHOICE” Choice of Creep Fluid on Critical Care Outcomes — cluster-controlled multicentre trial on the choice of creep/maintenance fluids and their impact on clinical outcomes

“GODIF” Goal-Directed Fluid Removal with Furosemide in Intensive Care Patients with Fluid Overload — goal-directed diuretic therapy for fluid overload in the ICU

"INCEPT" The Intensive Care Platform Trial — international platform trial for the evaluation of various interventions in critically ill patients

“AI4ICU” Artificial Intelligence for Intensive Care — development and validation of AI-powered early warning systems and decision support systems for intensive care medicine

“PAP-EIT Study” Non-Invasive Measurements of Changes in Pulmonary Artery Pressure Using Electrical Impedance Tomography — feasibility study on non-invasive haemodynamic monitoring

“VExUS Meta-Analysis” VExUS Score to Identify Readiness for Fluid De-escalation in Critically Ill Adults — systematic review and meta-analysis on ultrasound-based readiness assessment

“FICUScale” Family-Focused Health Interventions in Intensive Care Units Scale-up — co-designed implementation-effectiveness trial on family-centred care in the ICU

ESICM Clinical Practice Guideline on fluid therapy: Part 3 — fluid removal at de-escalation phase
Ostermann, Pfortmueller et al. · Intensive Care Med, 2025

Fluid accumulation syndrome in sepsis and septic shock: pathophysiology, relevance and treatment
Pfortmueller, Dabrowski, Wise, van Regenmortel, Malbrain · Ann Intensive Care, 2024/2025

Influence of fluid accumulation on major adverse kidney events in critically ill patients
Hofer, Ruzzante, Waskowski, Messmer, Pfortmueller · Ann Intensive Care, 2024

Active fluid de-resuscitation in critically ill patients with septic shock: a systematic review and meta-analysis
Messmer, Dill, Müller, Pfortmueller · Eur J Intern Med, 2023

Fluid de-resuscitation in critical illness — a journey into uncertain territory
Pfortmueller, Dabrowski, Malbrain · J Crit Care, 2023

Utility and limitations of patient-adjusted D-dimer cut-off levels for diagnosis of venous thromboembolism
Gerber, Messmer, Pfortmueller et al. · J Intern Med, 2023

Hypertonic saline for fluid resuscitation in ICU patients post-cardiac surgery (HERACLES)
Pfortmueller et al. · Intensive Care Med, 2020

Fluid overload and mortality in adult critical care patients — a systematic review and meta-analysis
Messmer, Zingg, Müller, Pfortmueller et al. · Crit Care Med, 2020

Renal function adjusted D-dimer levels in critically ill patients with suspected thromboembolism
Schefold, Gerber, Pfortmueller et al. · Crit Care Med, 2020

Fluid management in patients undergoing cardiac surgery (HEMACETAT)
Pfortmueller et al. · Crit Care, 2019

University Emergency Centre
Prof. M. Müller, MD, Prof. W. Hautz, MD

Nephrology & Hypertension
Prof. U. Hyen-Do, MD

Pulmonology
Annina Büchi, MD

Oncology
Kristina Vrotniakaite-Bajerciene, MD

Phagenesis Lab
Prof. Yok-Ai Que, MD

Kantonsspital St. Gallen
Urs Pietsch, MD, Prof. Miodrag Filipovic, MD

Kantonsspital Luzern
Andreas Bloch, MD, Annika Reitam-Blaser, MD, Benjamin Hess, MD, Jan Scholte, MD

University Hospital Zurich
Dr. Rahel Sutter, Implementation Science

ETH Zürich
Prof. Gunnar Rätsch

University of St. Gallen (HSG)
Justus Vogel

University Hospital Geneva
Prof. Hervé Quintard, MD

International Fluid Academy
Prof. Manu Malbrain

University Hospital Antwerp
Prof. Niels van Regenmortel

University Hospital Copenhagen
Prof. Morten Hylander Møller

CRIC Copenhagen
Prof. Dr. med. A. Perner

Medical University of Vienna
PD G.-Ch. Funk, MD, Prof. Arabella Fischer

ESICM
European Society of Intensive Care Medicine

• Publications of Carmen Pfortmueller on PubMed
• Carmen Pfortmueller on ORCID