IFA Talks

I am Eric Hoste from University Hospital Ghent in Belgium. Fluids and acute kidney injury (AKI) present a complex relationship—one that can be described as the good, the bad, and the ugly. Fluids are undoubtedly beneficial in cases of hypovolemia. When administered appropriately, they help restore intravascular volume, improve renal perfusion, and can effectively prevent the onset of AKI. This is the "good" part of the story.

However, fluids can also be harmful when given in excess. Overzealous fluid administration increases venous congestion and raises renal afterload, which in turn compromises kidney perfusion and promotes the development of AKI. This represents the "bad" side of fluid therapy.

Finally, there's the "ugly"—certain types of fluids themselves can directly contribute to kidney injury. Some colloids, particularly older generation starches, have been associated with nephrotoxicity. Similarly, hyperchloremic crystalloids like normal saline can induce metabolic acidosis and renal vasoconstriction, further exacerbating renal injury.

In essence, fluid therapy in critically ill patients must be carefully balanced. The right type, dose, and timing are critical in protecting the kidneys and avoiding unintended harm.

My name is Dirk Himpe, and I am an anesthesiologist at Middelheim General Hospital in Antwerp, Belgium and I am primarily involved in cardiac anesthesia for patients undergoing cardiac surgery. We know that long-term outcomes after cardiac surgery are significantly influenced by the administration of blood, blood products, and the occurrence of anemia—often caused by hemodilution during the procedure.

The focus of my talk was on fluid management during cardiac surgery, particularly during cardiopulmonary bypass, a phase where large volumes of fluid are administered. I explored whether the type of fluid given during this period can impact patient outcomes. Specifically, the addition of colloids may help improve fluid balance. It is also crucial to use fluids that do not interfere with hematocrit levels, thereby reducing the need for blood transfusions. Furthermore, choosing fluids that minimize inflammation is essential to improving recovery and overall outcomes. These are the key considerations we must keep in mind when managing fluids in this setting. Thank you.

Hello, my name is Christian Putensen from the University of Bonn. I recently gave a talk on respiratory monitoring in patients with ARDS. For many years, we've recognized that ARDS is not a uniform condition—it is a highly heterogeneous disorder. Traditional respiratory monitoring techniques, such as airway pressure measurements, do not provide sufficient information about the actual stress applied to the lungs. This is why measuring esophageal pressure and intra-abdominal pressure has become increasingly important. These methods help us better understand transpulmonary pressure, which is a key factor in the development of ventilator-induced lung injury. Additionally, emerging technologies such as electrical impedance tomography now offer valuable insights into regional ventilation and compliance. These advancements may further help us refine ventilatory settings and improve patient outcomes.

My name is Can Ince, and I'm based in Amsterdam at the University of Amsterdam's Academic Medical Centre, where I serve as Head of the Department of Translational Physiology. In addition, I work two days a week as a physiologist in the Department of Intensive Care Medicine at Erasmus Medical Centre. My area of expertise focuses on the behavior of fluids, oxygen transport, and blood flow at the cellular level within the microcirculation—because that's truly where the critical processes take place. I've developed technologies to observe and better understand these mechanisms. In my lecture, I will explore the dynamics of oxygen transport to tissues via fluids and blood, and how these processes interact with the vascular endothelium, with a particular emphasis on their implications for renal function.

The subject of my talk was the perioperative management of patients undergoing high-risk surgery. This remains a significant challenge in clinical practice, as a large number of patients require such complex surgical interventions, and the associated complication rates are still considerable. One promising strategy to improve outcomes is the implementation of goal-directed therapy. By closely monitoring and optimizing fluid administration during the perioperative period, we can potentially reduce complications and enhance recovery. However, despite encouraging evidence, several unresolved questions and areas of uncertainty remain regarding this approach. In my talk, I aimed to shed light on these controversies and explore potential pathways for improving patient care in this high-risk population.

My name is Michael Bauer, and I'm from Jena, Germany. My area of interest is dye dilution techniques. Traditionally, our approach in critical care has focused on maximizing blood flow to tissues, often without fully considering the potential side effects of such aggressive strategies. However, I believe it's time for a paradigm shift. Instead of simply increasing perfusion, we should aim to match blood flow to the actual metabolic demand of the tissues. Dye dilution techniques offer a valuable tool to help us achieve this more individualized and precise approach to hemodynamic management.

My name is Paul Elbers, and I'm from Amsterdam, the Netherlands. I'm proud to be part of the first telemedicine unit established in Europe. In my presentation, I focused on saline-induced metabolic acidosis—a real and clinically significant phenomenon. Using the Stewart approach, I explained how this framework helps us better understand the underlying mechanisms and why this condition can be harmful to many patients. When managing critically ill individuals, every detail matters, including fluid composition. That's why my key message was simple but important: think twice before choosing saline.

I am Dirk Himpe, a cardiac anesthesiologist at Middelheim General Hospital in Antwerp, Belgium. In my presentation, I discussed the use of hypertonic solutions in clinical practice. Sometimes, it is beneficial to administer highly concentrated saline solutions to draw water from areas in the body where it has accumulated abnormally. By doing so, we can shift fluid back to where it is needed most. These hypertonic, or very salty, solutions can effectively help manage fluid distribution, especially in cases of fluid overload or compartmental imbalances. This principle formed the core of my talk.

My name is Eric Hoste, and I work at Ghent University Hospital in Belgium. In my talk, I addressed the ongoing debate around whether colloids or crystalloids are superior for volume replacement in critically ill patients. Overall, the evidence shows that colloids are not superior to crystalloids in the general ICU population—they tend to be more expensive and are associated with a higher risk of side effects. However, there are certain subgroups of patients, such as those with severe sepsis, undergoing cardiac surgery, or suffering from cirrhosis, where colloids—particularly albumin—may offer specific benefits. In patients with cirrhosis, for instance, albumin has been shown to support better kidney function. These findings suggest that while colloids may not be the first choice for all, their targeted use in select populations warrants further investigation.

My name is Sybille Kozek, and I'm an anesthetist from Vienna, Austria. One of my main areas of interest is the potential side effects of colloids and crystalloids, particularly in relation to dilutional coagulopathy and their impact on clinical outcomes such as blood loss and transfusion requirements. In my lecture, I focused on why fluid choice truly matters—not just in terms of the type of colloid, but also the timing and dosing of its administration. I presented evidence highlighting the clear clinical advantages of using 6% iso-oncotic tetrastarch compared to gelatin, emphasizing its superiority based on the data currently available.