IFA Talks

I am Rob Wise and in South Africa, we normally maintain a supply of about two to three days' worth of emergency blood. But recently, we were down to just 0.7 days. That's not a warning sign—it's a national crisis. A severe shortage of blood products is placing enormous strain on healthcare services.

My lecture focused on the use of fluids in resource-limited countries. One of the most important messages I wanted to convey is that the developing world faces challenges that many in high-income countries simply do not encounter. The reality on the ground can be drastically different.

The fluid research currently being conducted is incredibly valuable, and I applaud the progress being made. However, it's crucial that we include resource-limited settings in both the research and the solutions. Otherwise, the recommendations won't be applicable or helpful for those who need them most.

When clinicians have no choice at all—for example, only one fluid available—the outcome is dissatisfaction and frustration. When there are too many choices, the decision becomes overwhelming. Interestingly, offering just the right amount of choice—around six options—leads to the greatest satisfaction. This metaphor captures the complexity of decision-making in both resource-rich and resource-poor environments.

This is my first time attending IFAD, and I'm truly enjoying the experience. It's fantastic to meet so many people from around the world and to share experiences and challenges. This meeting has been both educational and inspiring, and I look forward to being a part of it again.

One of the key advantages of colloid fluids in the operating room is their ability to provide a pronounced and stable plasma volume expansion. Unlike crystalloids—where most of the fluid tends to disappear from the vascular space within 30 minutes—colloids remain longer, offering more sustained intravascular support.

I am Robert Hahn from Sweden and I've had a long-standing interest in fluid therapy, and at this meeting, I'm giving a lecture on the kinetic modeling of fluids—a powerful tool that helps us understand how different types of fluids behave in the body, and how we can use this knowledge to optimize fluid management in clinical practice.

Over the decades, one of the most concerning observations I've made is that we tend to overlook the patients at both extremes—the ones who are being desiccated and those who are being drowned to death by fluid overload. This is where we need to sharpen our focus.

My goal is to ensure that clinicians become more familiar with the basic science behind the fluids they use every day. It's important to understand how these fluids distribute, how quickly they are eliminated, and how they interact with the body's physiology. With that knowledge, clinicians can make more informed decisions and avoid both under- and over-resuscitation.

We need technology to help us—not necessarily to work harder, but to work smarter.

I am Yazine Mahjoub from France. Yesterday, I had the opportunity to give a lecture on the right ventricle and how to evaluate right ventricular function using Doppler echocardiography. I emphasized to attendees that while this technique is relatively easy to perform, it does require practice and training, especially in the intensive care setting, where such evaluations are often crucial.

My main take-home message was this: In any ICU patient in shock, we must always consider acute cor pulmonale as part of our differential diagnosis. Doppler echocardiography is an extremely useful and accessible tool for assessing right heart function in these situations and can guide important clinical decisions.

This congress is especially important because it brings together experts from all over the world, creating a space to exchange diverse perspectives on some of the most serious and complex topics in critical care. These conversations help us broaden our thinking, challenge our assumptions, and ultimately improve how we care for our patients.

I am the Scientific Chairman of the Society of Cardiac Anesthesiologists of Thailand, and I've been traveling across Asia to promote fluid therapy and goal-directed therapy throughout the region.

I must say, I found this meeting to be truly outstanding. It offers a global update on the latest data and practices in fluid management, all presented in an accessible and engaging format.

While this may not be one of the largest meetings, it is certainly one of the most valuable. The quality of the content, the depth of discussion, and the opportunity to interact with international experts make it a very, very good meeting.

Next year, I will actively promote this event across Asia and encourage more colleagues to attend. I strongly believe that many physicians from our region would benefit tremendously from being part of this growing community.

As we previously published, the Mortality Prediction Model version II appears to be the most accurate tool for predicting maternal mortality in obstetric populations, particularly in low- and middle-income countries such as Colombia and others in Latin America.

Our presentation focused on the use of severity of illness scores in pregnant patients. We evaluated several general severity indices and assessed how effectively they measure the clinical condition of obstetric patients. After completing our analysis, we concluded that the Mortality Prediction Model II outperformed other models in predicting maternal mortality within our specific patient population in Colombia.

One interesting observation during our study was seeing age listed as the first variable—something that's rarely emphasized in European models. It sparked some fascinating discussion, as this may reflect unique demographic or clinical realities in different regions, and certainly warrants further exploration.

This meeting has been an incredible experience. I was genuinely surprised—and inspired—by the diversity of participants, coming from all over the world. The exchange of experiences, especially around fluid management, has been extremely enriching.

What makes this congress special is that it doesn't focus solely on the critically ill adult population, but also includes discussions around surgical, obstetric, pediatric, and neonatal patients. That breadth makes it truly unique—and a valuable learning opportunity for all of us.

Let's try not to swing the pendulum too far in the other direction—risking another form of high mortality. Instead, let's aim to find the sweet spot.

My lecture focused on de-resuscitation in the critically ill—and whether this could be the key to solving the problem of fluid overload. As we've seen, aggressive fluid administration may save lives in the early phases of shock, but excess fluids later on can be harmful, and managing this balance is critical to improving outcomes.

One of the great strengths of the IFAD Congress is that, unlike broader ICU meetings where a wide range of topics are only briefly touched on, here we can focus deeply on one essential area: fluid therapy. This narrow focus allows for in-depth presentations, richer discussions, and more meaningful exchanges between experts.

I believe it's also important to highlight the value of collegial interaction at meetings like this. While randomized controlled trials (RCTs) remain essential, we are increasingly recognizing the importance of understanding how to translate those results into clinical practice. And that's something you can only refine by sharing real-world experiences and perspectives with your peers.

This congress provides exactly that kind of environment—specialized, collaborative, and clinically relevant.

Simplicity is key. We need to keep things simple—because even experts often struggle to interpret complex data. That's why it's crucial to ensure that data are not only easy to access, but also easy to understand and act upon.

My name is Geert Creemers, and I'm the CEO and founder of Argon Measuring Solutions. I'm probably one of the few, if not the only, non-medically trained professionals attending this conference. I come from the industrial sector, where we specialize in high-precision 3D measurement technologies.

In a conversation with Prof. Manu Malbrain, the organizer of this congress, we discovered some fascinating parallels between the medical and industrial worlds. While our sectors may seem different on the surface, we face similar challenges—particularly around data usability, decision-making, and real-time feedback.

Over the past five to ten years, our industry has learned some important lessons—lessons that, I believe, could be highly relevant to the medical profession:

• Keep systems simple

• Deliver data quickly to the right people, whether that's an engineer or a doctor, an operator or a nurse

As a company, we're now exploring opportunities to adapt some of the platforms and solutions we've developed for industry to meet the needs of the medical field. We believe that cross-sector collaboration like this could bring real value—especially in an era where precision, speed, and clarity are more important than ever.

Hi I am Annika Reintam Blaser from Estonia and when we talk about enteral nutrition, it's important to clarify that it can be administered via gastric, jejunal, or even transgastric routes—and each of these approaches matters. They are not interchangeable, and the route of administration can have a significant impact on tolerance and outcomes.

In my lecture, I presented the European guidelines on early enteral nutrition in critically ill patients. These guidelines represent a substantial collaborative effort, and we developed them with a clear goal: to make them practical and applicable at the bedside, supporting clinicians in their daily decision-making.

However, it is equally important to recognize the limitations of our current knowledge. The evidence base is weak, and as a result, all of our recommendations are conditional. That transparency is essential. We don't want to oversell certainty where it doesn't exist.

Another critical point I want the audience to remember is this: Even when early enteral nutrition is indicated, it should always be initiated slowly and carefully. Critically ill patients are vulnerable, and nutrition must be introduced in a way that supports recovery without causing harm.

In summary:

• There are meaningful differences in route of delivery.

• The current guidelines are practical, but the evidence is limited.

• And regardless of indication, early enteral nutrition must be started with caution.

I am Fabio Taccone from Brussels, Belgium. When you look at real patients—and not just models—undergoing CPH (continuous purification therapies) and measured for antibiotic concentrations, what you find is striking: there is huge variability in how these drugs behave.

I was invited to speak about the association between fluids and fluid overload, specifically in relation to pharmacokinetics—the study of how drug concentrations change over time in the body.

I shared two key messages with the audience:

1. Pharmacokinetics in critically ill patients is highly unpredictable. In the ICU, we often administer therapies without fully understanding how these drugs are processed. Critical illness alters drug behavior—absorption, distribution, metabolism, and clearance—and we cannot always predict how much of the drug will reach its target.

2. Fluid therapy can significantly alter drug concentrations. When we administer fluids, we're not just "filling the tank"—we're expanding the volume of distribution for many drugs. This can dilute plasma concentrations and, in some cases, increase drug clearance. In other words, fluid management directly affects the effectiveness of antibiotic therapy and other medications.

The big takeaway is this: when we measure drug concentrations in actual ICU patients—outside of pharmacokinetic models—the variability is enormous. You cannot rely on standard dosing or one-size-fits-all assumptions. What works in theory or in stable patients may not work at all in critically ill individuals.

This highlights the importance of Therapeutic Drug Monitoring (TDM) in the ICU. If we truly want to personalize therapy and improve outcomes, we must measure and adjust based on real-time pharmacokinetics, not outdated models.

This meeting has been a great platform for these kinds of discussions. It's a focused congress—dedicated entirely to fluids—allowing us to explore specific aspects of fluid management that often get overlooked in larger general conferences. It's also a fantastic opportunity to network, meet colleagues and friends, and hear the latest research and thinking in this evolving field.

The meeting is clearly growing in participation, the organization is excellent, and the location is ideal. It's a pleasure to be part of it.

Hi, I am Jan De Waele from Ghent, Belgium. At this meeting, fluid therapy has rightly taken center stage—with many presentations and discussions focused on when and how to give fluids. But far fewer have tackled the other side of the coin: fluid removal.

In my talk, I addressed a topic that's gaining attention yet remains understudied: the dangers of fluid de-escalation. While it's a common intervention, we still have limited understanding of the potential risks involved. These risks are closely tied to both the methods and the rate at which fluids are removed.

I provided an overview of the different aspects of de-escalation—its role, clinical rationale, and, most importantly, how to apply it safely at the bedside.

Of course, the best-case scenario is to avoid excessive fluid administration in the first place. That's a no-brainer. Prevention is always better than cure. A good place to start is by carefully monitoring the cumulative fluid balance from the beginning of treatment.

But when de-escalation is needed, it's crucial to understand that it can come with significant risks—not only in the short term, but potentially with long-term consequences as well. Simply looking at fluid balances and lab values isn't enough. Effective de-escalation demands clinical judgment, careful patient evaluation, and a keen sense of timing.

One of the biggest challenges is identifying the turning points—those critical moments when the patient is truly ready for fluid removal. Get it wrong, and you may cause more harm than good.

This is not my first time at this meeting, and I've been excited to see how it continues to grow with every edition. It's clear that fluid therapy is a core issue in critical care, but it's also clear that we need more scientific data, especially when it comes to how and when to remove fluids safely.

This is a challenge we'll need to tackle in the coming years. We're not there yet.