IFA Talks

One of the more technical yet fascinating aspects I discussed was freeze substitution, a technique performed at -90°C, where water remains mobile, but larger molecules are immobilized. During this process, we introduce acridine orange and uranyl acetate, which results in a "fluffy" structural visualization—a revealing view into the delicate architecture we're studying.

What I want the audience to understand is the crucial role of the glycocalyx—not just as an isolated structure, but as a dynamic, functional layer of the cell surface. It plays a vital role in cell behavior, communication, and vascular integrity, and its condition changes dramatically between health and disease.

My personal focus is on the impact of diabetes. In diabetic patients, the glycocalyx becomes disrupted, which contributes to a host of microcirculatory problems—in the kidneys, retina, and lower limbs. These complications are common and devastating, and they correlate strongly with glycocalyx degradation.

We believe the glycocalyx is a key player in diabetic vascular complications, and our hope is to one day restore or rebuild a healthy glycocalyx, which could help reestablish proper endothelial function and ultimately preserve vascular health.

This research opens a door not just for better understanding, but for potential therapeutic interventions—aiming to consolidate the vasculature and mitigate the progression of diabetes-related organ damage.

In extracorporeal support systems like ECMO, understanding pressure dynamics is key. For example, internal pressure refers to the pressure after the pump head but before the oxygenator. By comparing this with the arterial pressure, we calculate the pressure gradient (delta P) across the oxygenator—a critical metric for assessing oxygenator function and circuit performance.

Our mission today is to bring clinicians closer to advanced therapies like ECMO, including not only how to initiate them but also how to monitor the system and the patient holistically. ECMO remains a complex and high-risk therapy, and our goal is to demystify it, making it more accessible and manageable for those facing critically ill patients.

In practice, we've opted to keep circuit connections consistent—for instance, connecting venous to venous (phenocyte to phenocyte) and arterial to arterial (arterioscite to arterioscite)—to reduce the risk of complications and standardize care protocols.

Fluid dynamics, in this context, is all about measuring and knowing. It allows us to adapt therapy in real time, track patient evolution, and predict clinical course. By understanding where a patient came from, where they are today, and what trends are unfolding, we can tailor our treatment for tomorrow. This kind of monitoring isn't optional—it's essential to optimizing outcomes.

Once you've performed pressure zeroing inside the Cardiop system, you're ready to prime the circuit—a critical step before initiating support. But beyond the technical aspects, there's a deeper message here: If we have an opportunity to educate healthcare professionals, we must take it—and we must do it consistently. New regulations highlight the need for structured, recurring training—every two years, for example—to maintain safe and effective practice.

At the end of the day, the best patient outcome is what drives us. And that's why we come together—to share knowledge, refine our techniques, and learn from each other. That, in many ways, is what makes IFAD such a valuable and collaborative community.

Over the years, the trend in fluid therapy has been clear: we're using fluids less and less. But if we project that trend too far into the future, we might imagine a time when we stop using fluids altogether—and I simply don't see that happening.

There has to be a balance point—a place where we can appreciate both the benefits and the risks of fluids, and use them wisely. That's the real challenge: finding that middle ground.

The importance of this conference is considerable, because many doctors are still confused about fluid therapy. On the one hand, fluids are the cornerstone of resuscitation. No matter what type of shock a patient presents with, our instinctive first move is usually to give fluids.

But at the same time, we face a number of uncertainties:

• How much fluid should we give?

• What type of fluid is best?

• What endpoints should we target?

• How do we know when to stop?

So while fluid therapy is common practice, it's also a source of common confusion.

That's why meetings like this one are so important. They help us clear the fog, consolidate the latest evidence, and define clear, practical goals that clinicians can apply at the bedside.

This is the environment I feel most comfortable in. Put me in a general practice setting—sitting in a quiet room with a patient—and I get nervous. My hands sweat, my heart races. But in the complex, high-stakes environment of intensive care, I feel completely at home.

I am Matthew Morgan and I just delivered a talk that partially explored the history of intensive care medicine, which dates back to the 1953 polio epidemic in Copenhagen. From those early days, I traced how the specialty has evolved over the decades, and how far we've come in our ability to support critically ill patients.

But my real message to the audience was about something even more important: the need to engage with the public. We must do a better job of explaining what intensive care medicine actually is, the uncertainties we face, and the delicate balance between what we can do and what we should do.

They say it takes 10,000 hours to become an expert—but I tried, in just 15 to 30 seconds, to share my approach to intensive care: it's about teamwork, humanity, and curiosity, as much as it is about science and technology.

I'm proud to be here not just as a speaker, but as part of a research team from Cardiff. And not just physician researchers. I've travelled here with two research nurses, who do the real heavy lifting—recruiting patients, coordinating protocols, ensuring the work actually gets done. I'm also joined by an academic foundation doctor, whose enthusiasm and insight keep our team fresh and forward-looking.

Because the reality is this: Research in medicine is a team game. And coming to conferences like this—not just as individuals, but as a team—is hugely beneficial for learning, for collaboration, and for building the future of our specialty.

The sodium conundrum. A conundrum is a riddle, a brain teaser, an enigma. So perhaps a better title for my talk would be: "The Riddle of Salts."

I am Niels Van Regenmortel from Antwerp in Belgium and what I'm most passionate about in fluid management today is this: We should be doing much more to avoid excessive sodium administration in hospitalized patients.

Why? Because sodium—not just fluid—is a major contributor to fluid overload in our patients. This issue goes beyond the volume of fluids we give—it's also about the sodium content of those fluids.

So how can we reduce sodium overload?

There are two key strategies:

1. Use hypotonic maintenance solutions. We should avoid routine use of isotonic maintenance fluids, except in very specific cases, such as patients with brain edema, where sodium balance is critical.

2. Avoid "fluid creep" and "salt creep." These are the hidden sources of sodium that come in through medications, flushes, and infusion carriers. They often go unnoticed but can significantly contribute to daily sodium load.

Let's also remember that potassium often gets an unfair reputation. The normal dietary intake of potassium ranges from 40 to 120 mmol per day. People panic when serum potassium rises slightly above 5 mmol/L, but that's just what's circulating in the blood. In reality, our bodies are well adapted to much higher potassium intake. For example, a single glass of orange juice contains about 120 mmol of potassium.

Finally, I'd like to emphasize the importance of this Congress. It fills a critical gap—because no other meeting is dedicated solely to fluids. And yet, fluid management is central to the care of every hospitalized patient. Every clinician, in every specialty, should be thinking carefully about how fluids—and particularly sodium—are being managed.

I am Mike Smet from Antwerp in Belgium. When I'm teaching echocardiography, I always remind my students that there are really just three basic probe movements:

• You either rotate the probe,

• Slide the probe along the body,

• Or tilt it to change your angle of view.

These simple techniques form the foundation of ultrasound scanning—and once understood, they empower clinicians to begin exploring visual medicine.

This is a beginner's course, designed to spark interest in both basic and more advanced ultrasound applications. Point-of-care ultrasound is truly a revolution in bedside medicine—it allows for faster and more accurate diagnoses. For example, if a patient presents with shortness of breath, a basic lung or cardiac ultrasound can lead you to the correct diagnosis within minutes.

One of the key diagnostic distinctions we teach is how to tell the difference between pleural and pericardial fluid:

• If the fluid lies behind the heart and behind the aorta, it's pleural fluid.

• If it lies in front of the aorta, it's pericardial fluid.

Our hands-on training sessions are particularly valuable for those who have never used ultrasound before. They provide a chance to view the basic cardiac and abdominal scans, helping participants become familiar with a form of medical imaging once reserved for radiologists.

But ultrasound is rapidly expanding—it's no longer confined to imaging departments. It's coming to every floor: the emergency department, the ICU, and even the general wards. It's becoming an essential tool for clinicians everywhere.

We encourage learners to start with big, sweeping motions—like battleships—as they navigate their first scans. And soon, they'll begin to recognize the structures and signs that lead to confident, bedside diagnosis.

Atrial fibrillation (AF) is likely the most frequent supraventricular arrhythmia encountered in clinical practice—and in the ICU, it's also a leading cause of diastolic heart failure.

I am Martin Balik from Czech republic and in my lecture, I focused on the potential role of short-acting beta-blockers, particularly landiolol and esmolol, in the management of atrial fibrillation in critically ill patients. These agents offer unique advantages due to their short half-lives and rapid titratability, making them ideal for the dynamic environment of the ICU.

In this setting, it's crucial to optimize preload, taper catecholamines, and consider early rhythm control, especially for the prevention of heart failure. My approach is grounded in cardiovascular stabilization, rather than simply rate control.

However, this kind of therapy requires a complex and individualized approach to monitoring. The decision to use short-acting beta-blockers should be based on advanced hemodynamic assessment, ideally supported by echocardiography. This allows us to identify a select group of patients who are likely to benefit from this therapy without compromising cardiac output or perfusion.

What I appreciate most about this congress is that it's not just a platform to lecture— I also have the opportunity to organize echo workshops, contribute to the main program, and most importantly, learn from other prominent speakers from around the globe.

The International Fluid Academy Days (IFAD) brings together world-class experts, offering cutting-edge education and discussion on topics that are highly relevant to real-life critical care. It's a privilege to be part of it.

What is the effect of renal replacement therapy (RRT) modality on renal recovery in critically ill patients? I am Hilde De Geus from The Netherlands and that was the focus of my lecture—looking specifically at whether the choice between hemofiltration and dialysis impacts renal outcomes.

There's a common myth in intensive care that hemofiltration is somehow superior for renal recovery. However, the literature I presented clearly shows that there is no significant difference between hemofiltration and hemodialysis in terms of their impact on renal recovery.

While convective therapies like hemofiltration may provide more efficient clearance of large molecules, this does not translate into improved renal outcomes. On the other hand, dialysis offers more favorable technical characteristics:

• Lower blood flow requirements

• Lower filtration fraction These make it more practical and sustainable in critically ill patients.

So, the main takeaway is this: There is no clear advantage of hemofiltration over dialysis in terms of renal recovery, and based on technical simplicity and physiological tolerance, continuous hemodialysis may be the more logical choice in many ICU settings.

As for the broader question—does RRT influence renal recovery at all?—the evidence suggests that the modality itself is not the determining factor. This is an area where more nuanced understanding is needed, but we should be cautious about assigning undue benefit to one approach over another without clear evidence.

This congress is truly well-educated and evidence-based. The level of discussion is state-of-the-art, and it's an honor for me to be here as a speaker. I would strongly encourage others to attend—because if you want to stay up to date with the latest, most reliable evidence in fluid and renal care, this is the place to be.

Why are we still giving fluids to test fluid responsiveness? Today, we have methods to predict fluid responsiveness without administering a single drop of fluid. I'm referring, of course, to the passive leg raising (PLR) test, which functions as a reversible fluid challenge.

I am Xavier Monnet from Paris in France and in my lecture today, I focused on the concept of fluid challenges—or more precisely, preload challenges. What we really need is not a fluid challenge that risks overloading the patient, but rather a safe and reversible preload test to determine whether the patient is preload responsive.

That's why I advocate for using passive leg raising. It's a dynamic and physiological way to test the patient's position on the Frank-Starling curve—at the bedside, in real time. If cardiac output increases during PLR, you can reasonably assume that it would also increase after giving a real fluid bolus—without actually needing to give one. This helps avoid unnecessary fluid administration and the risks that come with it.

It's important to recognize that fluid challenges inherently risk fluid overload, especially if repeated. This is why we should shift toward preload challenges without fluids, using PLR as a safer and more effective alternative.

I've been attending this congress since its very first edition, and I can honestly say it's a wonderful event. What makes it unique is its dedication to fluids, not just from a clinical angle but starting with foundational physiology and extending all the way to practical bedside tools like cardiac ultrasound.

The faculty list is outstanding, and what really stands out is the quality of the attendees—these are people with a genuine interest in hemodynamics, people with a strong hemodynamic culture. Conversations here are always stimulating, meaningful, and clinically relevant.

This congress truly ranks among the most interesting and high-value meetings in critical care across Europe.

I am Jan Poelaert from Brussels, Belgium and it's undeniably difficult to distinguish between lung tissue and thrombus on ultrasound, especially in certain patient populations. During the CACU (Critical and Acute Care Ultrasound) workshops, I spoke about some of these challenges, particularly in our newer patient populations, such as those with obesity, where cardiovascular structures are harder to visualize.

This issue becomes even more pronounced in cervical patients, where access and image quality can be significantly compromised. One of the most critical parameters to assess in ICU and perioperative care is left ventricular (LV) function. It plays a central role in evaluating hemodynamic stability in critically ill, intraoperative, and postoperative patients.

In this context, transesophageal echocardiography (TEE) serves as a valuable hemodynamic monitoring tool, both intraoperatively and in the ICU. However, it's not without limitations. For example, in cases of abdominal surgery, introducing a transesophageal probe may be contraindicated, and the risks and benefits must be carefully weighed before proceeding.

What sets this congress apart is its specific focus on fluid management. It's a concise, two-day symposium that covers the entire spectrum of fluid-related issues in a highly structured and informative way. Despite its brevity, the content is rich and to the point, making it a very important and worthwhile event for anyone working in critical care.