IFA Talks

If you don't detect a lung sliding sign, it could indicate a pneumothorax—but it doesn't necessarily confirm one. Absence of sliding is suggestive, but not definitive.

My name is Willem Stockman, and I'm an anesthesiologist-intensivist at AZ Delta Hospital in Roeselare, Belgium. I'm here to speak about the use of ultrasound as a guidance tool for placing central venous lines and arterial lines—a technique that has become increasingly essential in modern critical care practice.

What I truly appreciate about this congress is that it's not just about learning new information, approaches, and techniques. A key part of the experience is the opportunity to connect with colleagues.

During the breaks, we have the chance to catch up, exchange ideas, and discuss the different practices and technologies used in other centers. Whether it's comparing clinical approaches or simply reconnecting with friends, the networking and shared experience make this meeting especially valuable.

This congress is not only a learning platform—it's a community. A great place to share knowledge, gain new perspectives, and stay connected with the broader critical care and anesthesia field.

I am Jan Poelaert from Brussels, Belgium. We often use transdiaphragmatic echocardiography—especially transesophageal echo (TEE)—to better understand what's happening in the left heart, and particularly the right heart, which can be difficult to assess with transthoracic views alone.

Today, I gave a lecture focused on transesophageal echocardiography (TEE)—an advanced approach to cardiac ultrasound performed via the esophagus. It's a powerful tool that allows us to gain detailed insights, especially in critically ill patients where transthoracic windows may be limited.

In addition to the lecture, there are hands-on workshops offered for both beginners and advanced practitioners who want to improve their echocardiography skills.

What I find very encouraging is the strong interest in the beginners' course—we've seen a high number of registrations and enthusiastic participation. This is a great sign, as it shows that many clinicians are motivated to learn and expand their skill sets.

You can really sense it in the workshops: attendees are eager, curious, and engaged, showing a genuine desire to explore different aspects of echocardiography and apply it in their clinical practice.

One important point to always keep in mind at the bedside is that there are limitations to using stroke volume variations during mechanical ventilation as a tool to assess fluid responsiveness.

My name is Xavier Monnet, and I work at Bicêtre Hospital in Paris, France. My lecture focused on the prediction of fluid responsiveness using echocardiography, a topic that has become increasingly important in today's critical care practice.

We now understand that administering too much fluid can be harmful and is associated with increased mortality, particularly in conditions like septic shock and ARDS. That's why it's absolutely crucial to predict fluid responsiveness before initiating fluid therapy—especially after the initial resuscitation phase.

Several tests and dynamic assessments have been developed for this purpose. During my presentation, I discussed those that can be performed with echocardiography, emphasizing their practical application at the bedside.

The iFAD meeting stands out as an exceptional event. It is uniquely focused on fluid management, and aside from myself, the faculty consists of top experts in the field. What makes this congress particularly special is its interactive workshop format, which fosters rich discussions and real-time exchanges between participants and speakers.

It's a rare and valuable opportunity to deepen your understanding of this critical aspect of hemodynamic management and to refine your clinical decision-making when it comes to fluid therapy

This is one of the first studies to report on the relationship between mean right atrial pressure and the diameter of the inferior vena cava (IVC) measured during expiration.

My name is Professor Vieillard-Baron. I am based in Boulogne, where I serve as the Head of the Intensive Care Unit at the university hospital.

My lecture focused on how to evaluate right ventricular (RV) function using echocardiography. I presented several clinical cases to illustrate to attendees how both transthoracic (TTE) and transesophageal (TEE) ultrasound approaches can be used effectively in mechanically ventilated patients.

We covered three main objectives:

1. Assessing RV function through echo parameters.

2. Performing diagnostic evaluations—particularly in cases where clots can be visualized in the right heart chambers or pulmonary arteries, which is crucial for the diagnosis of pulmonary embolism.

3. Using echocardiography in a different but important way: to help adapt ventilator settings based on hemodynamic findings, thereby optimizing respiratory support.

This is my second time attending this congress—my first was just last year—and I must say, it's an exciting and highly relevant event. The energy is great, and the level of discussion is impressive.

What sets this congress apart is its sharp focus on fluid management in critical care: how to choose the right fluids, how much to give, and when to stop. It provides up-to-date, evidence-based information that is incredibly valuable for managing critically ill patients more effectively.

You may observe very good contractility of the left ventricle, but if the afterload is significantly elevated, the ejection fraction may still appear reduced. This distinction is essential in understanding left ventricular performance.

My name is Michel Slama, and I am a Full Professor of Intensive Care Medicine at Amiens University Hospital in France. My lecture focused on left ventricular function, specifically on how to use echocardiography—a simple yet powerful ultrasound technique—to assess cardiac function, particularly that of the left ventricle, which plays a critical role in systemic circulation.

This congress, organized by Prof. Manu Malbrain, is a truly important and timely event. In intensive care, we are increasingly recognizing the crucial role that fluid management plays in patient outcomes. Whether we are administering fluids for resuscitation or for maintenance, our choices can have profound consequences.

For example, we now know that giving too much fluid can increase mortality in patients with shock. On the other hand, insufficient fluid resuscitation can also worsen outcomes. Therefore, finding the optimal fluid balance is key—not too much, not too little, but just the right amount needed to improve the patient's clinical condition without causing harm.

This is why meetings like this are so valuable. They bring us together to discuss the latest evidence, share best practices, and collectively improve the care we deliver to critically ill patients.

This is what I refer to as the correct terminology. We begin with the peri-heart, focusing on the heart itself—specifically, the volume status of the right ventricle.

My lecture today is about lung ultrasound, and from my perspective, the lung is just as vital as the heart. Traditionally, the lung was considered off-limits for ultrasound—it wasn't thought to belong in the domain of sonography. But I had a different experience.

When I began my training in intensive care medicine, I often found myself with free time during night shifts. With nothing else to do, I started scanning patients—day and night. Little by little, I discovered practical applications for lung ultrasound. One finding led to another, and gradually these pieces formed a cohesive and powerful tool.

Now, I deliver a one-hour lecture that captures the essence and potential of this method. While it's still a relatively new concept for many attendees, I've been working with it for over 30 years. My journey started in 1985, well before lung ultrasound became popular. Back then, I had to borrow the ultrasound machine at night—that's how it all began.

Over time, this work evolved. I was able to publish my findings, and those publications gave me the opportunity to share my voice—quite literally—with a microphone in hand. That's a privilege I deeply appreciate.

I was invited here by Prof. Manu Malbrain and his team, and I must say, he's a very efficient and visionary leader. The congress he has organized is truly impressive. Everything runs smoothly—well-planned, clear, and purposeful. I'm honored to be part of it.

It may be a small country, but the attendance is excellent, and the level of engagement and curiosity from the audience is genuinely inspiring.

I am Mike Smet. We use this view to examine the spleen and kidney. To obtain it, the ultrasound probe must be placed very posteriorly—so much so that your hand and the probe are both resting against the stretcher, with your knuckles often touching it. This positioning is essential to get a proper view of the retroperitoneal structures.

I work at the Middelheim Hospital of ZNA in ANtwerp, Belgium, where I practice as a specialist in internal medicine, intensive care, and emergency medicine. Today, I'm giving two sessions. The first one covers the basics of abdominal ultrasound, and the second focuses on the clinical applications of ultrasound in emergency and intensive care settings.

In each session, we emphasize three core elements:

1. A review of the basic anatomy relevant to ultrasound.

2. Demonstration of normal findings on ultrasound.

3. Presentation of common pathological images, helping participants recognize abnormalities.

The goal is to provide hands-on, practical knowledge so that participants can immediately apply what they've learned in their own clinical environments.

Still, I'd like to ask—which of the following methods most accurately identifies the location of a nasogastric (NG) tube in the stomach?

This is part of our ICU Quiz, specifically designed for intensive care nurses. I believe it's an excellent educational initiative because it encourages participants to think critically about their daily clinical practice. What stands out most is how engaged and enthusiastic the nurses are during the quiz.

The concept is simple but effective: we pose a series of questions covering cutting-edge topics in intensive care medicine. The quiz format is highly interactive, transforming traditional learning into a fun and competitive experience that boosts retention and promotes discussion.

For this edition, I was invited to contribute questions focused on extreme circumstances—a relevant and timely topic, given that nurses increasingly encounter patients in such scenarios. These include situations like marathon running, high-altitude exposure (e.g., climbing Mount Kilimanjaro or Mount Everest), and other physically demanding environments. My goal is to share insights on what complications might arise in these conditions and how to manage them effectively.

From my own experience, the International Fluid Academy Day (IFAD) is an outstanding congress. Why? Because it brings together highly respected international speakers, delivers deeply informative and up-to-date content, and consistently presents state-of-the-art lectures grounded in the latest evidence-based practices.

One of the key messages we emphasize is that clinical knowledge constantly evolves. Too often, healthcare professionals rely on information learned 10 or even 20 years ago. At IFAD, we strive to bridge that gap and ensure that clinicians are empowered with the most current, relevant knowledge.

What I appreciate most is how much we learn from each other. It's truly remarkable how many of the insights you gain here stick with you—and more importantly, how easily they translate into daily practice once you return to work.

This is my fifth time attending IFAD, so I've been part of it since the very beginning. And I can say with full confidence: this is a congress you don't want to miss if you want to stay sharp, informed, and inspired.

My name is Rainer Gatz. I work in one of the hospitals in Copenhagen. There are quite a lot of easy-to-learn applications in ultrasound which are fitting for beginners—this is essentially the essence of the FAST examination. These applications must be fast and easy to learn. Abdominal ultrasound is probably a bit more complicated, but even there, some applications are accessible to novices. I want to encourage people to take up ultrasound and get familiar with using the probe. Another important message is to always use the ultrasound probe before placing invasive devices, whether central lines or drainages for pleural or abdominal collections. This practice helps to avoid complications.

I am Daniel Lichtenstein, working in the medical intensive care unit at Ambroise Paré University Hospital in Paris, France. Lung ultrasound is only one part of the puzzle of critical ultrasound, and once it is standardized, it becomes, hopefully, much simpler than many people might think when they initially have no idea what it involves.

So my name is Michel Slama. I work in a medical ICU in Amiens, France. I gave a conference on left vascular evaluation using echocardiography. With echo, it is possible to assess ejection fraction, cardiac output, and pressures in the left ventricle. By using these different assessments, it becomes possible to guide therapy more accurately—to provide the appropriate treatment for patients in shock or those with pulmonary edema, for example.

I am Professor Antoine Vieillard-Baron from Boulogne-Billancourt, a small city very close to Paris. I want to convince everyone that using echocardiography is a valuable approach for evaluating heart-lung interaction. It is particularly helpful for adapting respiratory settings, especially in patients with acute respiratory distress syndrome (ARDS) and related conditions.

I'm Xavier Monnet. I work in Paris. In this short presentation, I tried to convey that it is now clear that excessive fluid administration is dangerous for patients, particularly those with septic shock. I described methods currently available to predict with echocardiography how a patient will respond to fluid administration. This predictive capability should help us avoid excessive fluid administration and fluid overload.

I'm Jan Poelaert from Brussels University Hospital, where I am chairman of the Department of Anesthesiology. This morning, I instructed advanced practitioners on how to evaluate major clinical issues in critically ill patients using transesophageal echocardiography. These issues include right ventricular dysfunction in hypoxemia, aortic dissection, and significant mitral and aortic valve diseases. In the afternoon, I showed participants images from transesophageal echocardiography to evaluate different cardiac structures and pathologies.

My name is Can Ince. I'm a physiologist working in the Netherlands. My presentation focused on the adverse effects of fluid administration and the conditions under which these effects occur. A key concept in the lecture was the idea of hemodynamic coherence—that is, a match between systemic hemodynamic parameters and tissue perfusion. When coherence exists, guiding fluid therapy based on macroscopic indicators like cardiac output and stroke volume is justified.

I'm Robert Hahn from Stockholm, Sweden. I serve as research director at a hospital in the southern outskirts of the region. I've long been interested in fluid therapy, particularly the kinetics of crystalloid solutions. These fluids behave very differently during surgery compared to normal states, such as in healthy volunteers. My talk focused on this contrast and also compared the behavior of crystalloids to that of colloid solutions.

I'm Luciano Gattinoni. I work at the University of Milan in Italy. Today's talk was dense and stimulating. We revisited the debate around targeting normal values in critically ill patients—should we always aim for normal? Personally, I believe that for certain variables, it is essential. These include those tightly regulated by the body, such as potassium levels.

My name is Jean-Charles Preiser. I work in the intensive care department of Erasmus University Hospital in Brussels. Today, I spoke about the continuous monitoring of glucose and lactate. I believe this represents a major advancement in the care of critically ill patients—not just for treatment, but also for clinical research. It allows us to better understand the physiological changes during critical illness. These changes cannot be fully appreciated without continuous monitoring. These devices are now validated in preclinical studies and ready for clinical use.

My name is Ingrid Baar. I'm a doctor at Antwerp University Hospital. I'm a neurologist, but I work in the intensive care unit. My talk focused on neuro ICU care, including hemodynamic management, fluid management, and electrolyte balance. I tried to convince my audience to maintain physiological norms and emphasized the importance of clinical judgment—using your clinical eye, not just relying on the numbers.

Hi, my name is Paul Marik. I'm from Norfolk, Virginia, in the United States. The topic I discussed today was early resuscitation in patients with severe sepsis and septic shock. This is a highly controversial area. I presented strategies that support a more conservative, restrictive approach to fluid resuscitation.

My name is Azriel Perel. I'm a professor from Tel Aviv, Israel. Today, I discussed therapeutic conflict—a situation where any clinical decision carries the risk of causing harm. We frequently encounter such dilemmas in the ICU. I presented an approach to resolving these conflicts, emphasizing the value of extended monitoring and the importance of thinking through the potential consequences of our clinical decisions.

I'm Dileep Lobo, Professor of Gastrointestinal Surgery at the University of Nottingham in England. My talk focused on maintenance fluids. These should aim to maintain a state of zero fluid balance without overloading the patient with water or salt. If we can achieve this, we could reduce postoperative complications by up to 41% and shorten hospital stays by about three days.

My name is Philippe van der Linden. I'm an anesthesiologist working in a hospital that serves both pediatric and adult populations. My talk explored whether hydroxyethyl starch can be replaced by gelatin solutions. The issue is more complex than it first appears, largely due to the lack of data supporting the safety and efficacy of gelatins.

Hello, I'm Stefan de Hert from Ghent, Belgium. I'm an anesthesiologist, and I presented on the use of starches in perioperative fluid management. My key message is that intravenous fluids should be treated like any other intravenous drug—with careful consideration of their indications, dosage, and risks.

I'm Djillali Annane, an intensivist in Paris, France. My task at the meeting was to discuss how my clinical practice has evolved following the CRYSTAL trial. This was a large randomized controlled trial conducted in nearly 10 countries, comparing resuscitation with colloids versus crystalloids.

My name is Jean-Louis Vincent. I'm Professor of Intensive Care Medicine at the University of Brussels and President of the World Federation of Societies of Intensive and Critical Care Medicine. My talk focused on the future of intravenous fluids. I opened by provocatively suggesting that we could discard all current IV solutions—they all have side effects, costs, and limitations. But rather than being overly critical, we must adopt a more open-minded perspective. In the future, I believe we may not need as many large randomized trials in broad, heterogeneous ICU populations. Different patients require different fluids, so I see IV fluids as drugs—each with potential side effects, and all potentially harmful in excess.

I'm Niels Van Regenmortel, one of the co-organizers of this meeting. My talk focused on the Stewart approach to acid-base analysis. This method brings electrolytes into the spotlight and offers a clearer understanding of acid-base disorders. Importantly, it can be used alongside the traditional approach, so my message is: use both.

I'm Manu Malbrain from Antwerp, Belgium. Today I gave a lecture on the assessment of fluid status. It's vital to monitor fluid status and track the evolution of fluid balance to avoid fluid overload. Several techniques are available today, and bioelectrical impedance analysis stands out as a promising method—though we still need further validation before it becomes routine.

I am Xavier Monnet from Paris in France. Today, there is strong evidence that excessive fluid loading is harmful to ICU patients. The good news is that we now have reliable tools to help guide our decisions: tools that indicate when to give fluids—and just as importantly, tools that help us determine when to withhold them. This allows us to tailor fluid therapy more precisely and safely than ever before.