IFA Talks

Hello, I'm Wilfried Mullens from Genk, Belgium. I just gave a talk on cardiorenal syndrome, a highly prevalent condition in which renal function deteriorates in patients hospitalized with heart failure.

Historically, we believed that this decline in kidney function was primarily due to poor forward flow—reduced cardiac output. However, recent insights have shifted our understanding. It's now clear that congestion—not low flow—is the key driver. Specifically, elevated filling pressures, and in particular right-sided filling pressures, contribute significantly to worsening renal function.

Another important factor is elevated intra-abdominal pressure, which further compromises kidney perfusion. Additionally, intra-renal hemodynamics and an imbalance in gut microcirculation also play a role in the complex interplay between the heart and kidneys in these patients.

I am Thomas Jack from germany. The focus of my talk is an often underestimated side effect of infusion therapy: particulate contamination. In my opinion, this issue does not receive the attention it deserves in clinical practice.

All infusion solutions we administer to patients carry a significant burden of particulate matter. These particles can originate from drug incompatibilities, formulation excipients, or may already be inherent in the drug preparations provided by pharmaceutical manufacturers.

While older experimental studies have long suggested that these particulates may be harmful, until now there has been no solid clinical evidence to support this concern.

In my presentation, I will share findings from the first clinical study conducted in a pediatric ICU, demonstrating that particulate contamination in infusion solutions is not just a theoretical risk—it can lead to serious, even disastrous outcomes. Most importantly, the study shows that by eliminating these particles, we can significantly improve patient outcomes.

I am Sybille Kozek from Vienna in Austria. In hemorrhagic shock, we are dealing with absolute hypovolemia, meaning there is a true loss of circulating blood volume. Therefore, the primary target of our fluid resuscitation is the intravascular compartment.

In this context, colloids can play a role as part of a multimodal resuscitation strategy, alongside crystalloids and blood products. However, their use must be carefully balanced with an awareness of potential complications.

We must consider the coagulopathic side effects of colloids, especially in patients already at risk of bleeding, as well as the potential for fluid overload or hypervolemia, which can worsen outcomes if not properly managed.

I am Rainer Gatz, from Copenhagen in Denmark.

Well, based on the findings from last year's studies and the current body of evidence, my main takeaway is that we should exercise caution when using colloids—particularly in septic patients. The potential risks may outweigh the benefits, and until we have more definitive data, it's wise to take a conservative approach.

There are ongoing trials, especially those evaluating the role of albumin in critical care, and their results will be crucial in guiding future practice. So for now, it's best to hold off on routine colloid use in sepsis and wait for the evidence to catch up.

I'm Niels Van Regenmortel drom ANtwerp, Belgium, and one of the co-organizers of this wonderful second International Fluid Academy Day together with Manu Malbrain. My talk focused on crystalloids, and I had some good news to share: we're now clearly favoring balanced crystalloids over saline.

In recent months, strong clinical data have emerged supporting this shift, which is a significant step forward in fluid therapy. I'm excited to see what the next year brings, but for now, we're very pleased with this progress and the growing support for balanced solutions.

Hi, my name is Monty Mythen. I'm from University College London in England. I just gave a talk on the engineering of next-generation resuscitation fluids—what we might call "superfluids"—and what the future holds in fluid development.

My key conclusions are that, over the next decade, most advances in resuscitation fluids will likely come from semi-synthetic products. These will be improved, modified, and reformulated to better match physiological pH and electrolyte compositions, making them safer and more effective.

Looking further ahead, we must continue to pursue the development of so-called "shelf blood"—a synthetic or engineered blood substitute. While this remains an unrealized goal, it's a critical frontier in fluid therapy, and one we must not abandon.

Hello, I'm Manu Malbrain, intensivist from Antwerp, Belgium. Today, I spoke about therapeutic conflicts in the ICU. Many critically ill patients develop therapeutic dilemmas—these are not static, but dynamic challenges that evolve over time. In addressing them, we must always prioritize support for the organ most at risk of causing a fatal outcome.

To navigate these conflicts, we need clear answers to four essential questions:

1. When should I start giving fluids? Not all patients require fluids. In some cases, the best fluid is the one never given. This phase is about understanding the benefits of fluid administration.

2. When should I stop giving fluids? At some point, ongoing fluid resuscitation becomes harmful. A positive cumulative fluid balance is more than a cosmetic issue—meta-analyses confirm it is an independent predictor of morbidity and mortality. This question relates to the risks of fluid overload.

3. When should I start removing fluids? Not all patients will transition spontaneously from the ebb to the flow phase of shock. Some require active intervention to promote de-resuscitation. This is about the benefits of fluid removal.

4. When should I stop removing fluids? Excessive fluid removal can be just as dangerous. A dry patient can mean a dry liver—potentially leading to fatal consequences. This question centers on the risks of overzealous fluid removal.

Ultimately, it's not just about choosing the right fluid for the right patient, but also delivering it in the right way and at the right time—using the appropriate monitoring tools tailored to the specific clinical situation. As we continue to push the boundaries of critical care, we must not lose sight of the microcirculation, which plays a crucial role in patient outcomes.

That was the essence of my talk.

I'm Jules Wendon, and my talk was about fluid therapy in patients with liver disease. When managing a patient with cirrhosis, getting the volume status just right is critical—not too little, and not too much.

An underfilled patient is at significant risk, as inadequate perfusion can worsen organ function. But overfilling is equally harmful. It can exacerbate edema, increase liver stiffness, and aggravate portal hypertension. Both extremes are dangerous.

In addition to careful fluid management, vasoconstrictors—particularly splanchnic vasoconstrictors—play a vital role. They help redistribute blood centrally, improve effective circulating volume, and counteract the central hypovolemia often seen in these patients.

Ultimately, it's all about balance. A little bit of this, a little bit of that. You need to take a step back and look at the whole picture. A holistic and nuanced approach is key to optimal patient care.

I am Jean-Louis Vincent from ULB Erasme in Brussels, Belgium. My talk focused on the types of fluids we can administer to our patients. While it's true that patients often need fluids, it's important to remember that not all fluids are inherently good—especially when given in excessive amounts. Intravenous fluids can help, but they can also harm.

Take albumin, for example. It's expensive, and there's no clear evidence of benefit in most situations. Hydroxyethyl starches (HES) have been linked to potential harm, especially in critically ill or septic patients. Gelatins are not well studied and might carry risks too—we simply don't have enough solid data to say they're safe.

Saline? Best avoided when possible—it contains a high chloride load, which can lead to hyperchloremic acidosis. Ringer's lactate is hypotonic, which may be an issue in some patients. Plasmalyte contains gluconate and acetate, and while it may be more balanced, we still don't fully understand how these components are metabolized in the body.

So, what's the ideal fluid? Honestly, there isn't a perfect one. Each type of fluid has pros and cons. I like to think of it like beverages in our daily life: a little bit of coffee, Coca-Cola, beer, or wine is generally fine. But too much of any of them? That's a problem. It's the same with intravenous fluids—moderation and context are key.

My name is Frédéric Michard, and I am responsible for the global medical strategy at MiCo Critical Care division. In addition to this role, I serve as a visiting doctor at the University Hospital of Lausanne. I'm truly pleased to be here today to discuss a topic that is both clinically relevant and impactful—fluid optimization in high-risk surgical patients.

We know from both clinical experience and growing scientific evidence that optimizing fluid therapy is one of the simplest and most effective strategies to enhance postoperative outcomes. When carefully tailored to a patient's individual needs, fluid management can reduce complications, shorten hospital stays, and ultimately improve survival rates. Despite its simplicity, fluid optimization remains underutilized, and raising awareness of its value is crucial to improving care for surgical patients worldwide. Thank you.