IFA Talks

I am Dirk Himpe from Antwerp Belgium. Gelatins are still considered the Cinderella of the colloids. Much like the fairytale character, they're often overlooked or spoken about in hushed tones—but they continue to quietly do a great deal of work behind the scenes. And perhaps, like Cinderella, they too have a promising future.

Gelatins are actually the oldest synthetic plasma substitutes, with their first use in humans dating back to 1915 during World War I. Their role expanded significantly during and after World War II, with ongoing modifications to improve their safety and applicability in critical care settings.

Today, we have several types of gelatin solutions, and it's important to note: they are not all the same. These solutions have evolved over time, and although they have stood the test of time, they have not always received the recognition they deserve in the scientific literature.

Despite their widespread use in many ICUs, gelatins are still underappreciated in academic and guideline-driven discussions. In many ways, they remain "Cinderella among the fluids"—doing the work, but rarely celebrated.

One key challenge is the lack of large, high-quality randomized controlled trials (RCTs). Today, the standard in fluid research is clear: if there's no RCT, the product or approach simply doesn't count at the level of evidence-based practice. This has pushed gelatins further to the sidelines in official recommendations.

However, there's now hope on the horizon. A multi-center RCT on gelatin use in ICU and septic patients has recently started in Germany. This may provide the evidence base we've been waiting for, helping to clarify the role of gelatins in modern fluid therapy.

So while they may still be the underdogs, gelatins have a rich history, a committed user base, and potentially, a bright future—provided we invest in the research needed to validate their continued use.

What is the importance of a meeting like this? I am Filip De Somer from Belgium and a meeting like this is incredibly valuable because it focuses on a relatively new technology—ECMO—that is increasingly being adopted outside of university hospitals. As its use expands into more general and community settings, it becomes essential for clinicians to have a clear understanding of both its indications and limitations.

It's not just about knowing how to initiate ECMO, but also about recognizing when it's appropriate to use, and critically, when a patient should be transferred to a more specialized center for advanced care. Meetings like this help ensure that ECMO is used safely, effectively, and in the right context, ultimately improving patient outcomes.

Do you know how long it typically takes for a piece of research to make its way into clinical practice? 16 years. Some say 17. That's an entire generation of medical graduates before evidence becomes routine care. It's far too long—and that's where tools like social media can help bridge the gap.

I'm Cian McDermott, an emergency medicine doctor, and I'm passionate about the use of point-of-care ultrasound (POCUS). I'm also very active on social media, where I regularly promote the integration of POCUS into everyday clinical practice.

Later today, in about half an hour, we'll be hosting a social media workshop focused on how these platforms can help you become a more active, engaged clinician. We'll share practical tips on how to use social media effectively and ethically in your professional life.

One inspiring example I often share involves a colleague who interviews patients about their experiences in the emergency department or ICU—stories like a mother whose child had meningitis. These interviews are posted online and serve as valuable educational tools, not only for clinicians but also for patients and families.

For me, the greatest power of social media is that it creates what I call a Personal Learning Network. It connects you to a global community of informed, intelligent, curious, and engaged professionals. And many of them are smarter and more experienced than I am—which is exactly why it's so valuable. I can learn from them, exchange insights, and contribute back to the community. It's not just about receiving information—it's about participating in the conversation.

One example of this power is a live Twitter debate that dissected a newly published paper within hours of its release. That kind of immediate, global discussion is what we mean when we talk about closing the knowledge translation gap. Instead of waiting weeks or months for feedback through traditional academic channels, we now have real-time engagement.

And it's not just the younger generation. More and more doctors across the age spectrum are beginning to see the value of social media in medical education and practice. At first, many think: "This isn't for me—it's too complicated, too time-consuming." But once they spend even a little time exploring, they often discover it's incredibly rewarding. You can learn more, faster, than you could from a single journal or even a conference.

Social media is not a distraction—it's an opportunity. And it's changing how we learn, share, and practice medicine.

Hi, I am Paul Elbers from The Netherlands and it's critically important to base fluid therapy on sound physiological principles, particularly those involving the right heart. You need to be careful when administering fluids and always consider the functional state of the right ventricle. If you give fluids when they're not indicated, you may worsen the patient's condition—the right heart can become distended, and this can impede left heart filling, ultimately leading to hemodynamic deterioration rather than improvement.

In other words, what seems like a helpful intervention can backfire, especially if the right heart is already compromised. So clinical context and understanding of cardiac physiology are absolutely key.

Another point worth noting is our use of diuretics—like furosemide (Lasix). If we indiscriminately remove just water, without accounting for solutes, we increase plasma tonicity. That shift can dehydrate cells, pulling water out of them and potentially causing harm, particularly in sensitive organs like the brain.

This is why understanding fluid composition, volume status, and cellular hydration is so important—it's not just about the numbers on a fluid chart.

What's great about this meeting is that everyone who truly understands fluids—or wants to—is here. As a speaker, it's a privilege to contribute, and it's exciting to engage with intensivists from all over the world who have come to learn, question, and share.

It's a fascinating mix of people, and the atmosphere is both collegial and intellectually stimulating. Meetings like this don't just teach—they build a global community committed to better, smarter patient care.

I am Joel Starkopf from Estonia, and I believe we have to start by looking at the patient in front of us. You can't impose a rigid mandate that every single patient must receive fluids, every time, without exception. Clinical decisions must be individualized, not protocol-driven for the sake of simplicity.

This is why meetings like this one are so valuable. It's a well-publicized and well-organized congress, held in a beautiful setting here at the Hilton Hotel in Antwerp. But more importantly, it's a place where experts and colleagues come together in a friendly and collaborative atmosphere to discuss what may seem like simple aspects of care—fluids and nutrition—but are in fact incredibly complex and nuanced topics.

We've seen something similar with oxygen therapy in recent years. At one point, oxygen was given almost reflexively to nearly every patient. Then the evidence shifted, and new guidelines advised against routine oxygen use unless truly indicated. But in some cases, we've now swung too far the other way, seeing underuse of oxygen in patients who actually need it.

We must be careful not to repeat the same mistakes with fluids.

For a long time, both fluid therapy and nutrition were neglected or treated as routine interventions—something basic and not worth much attention. But recent research has made it clear: it's not that simple.

Fluids are drugs. And like any drug, they come with potential side effects, risks, and benefits. We need to carefully consider the type of fluid, the dose, and the clinical context. That's why it's so enriching to gather here and discuss these subtle but important issues in critical care.

Lactate is your friend—not your foe. In fact, lactate infusion has been shown to improve cognitive and brain function in patients with traumatic brain injury. Yet, many clinicians still view elevated lactate with alarm, focusing on bringing the number down rather than understanding what it truly represents.

I am Paul Marik from the USA, and I gave three lectures during this conference:

1. One on the Surviving Sepsis Campaign,

2. Another on the use of vasopressors, and

3. The third on lactate physiology and interpretation.

Here's the core message from that last talk: You should not be targeting your therapy just to reduce lactate levels. Instead, target the patient—treat the underlying problem. Give antibiotics, initiate supportive care, manage fluids and vasopressors appropriately. And as the patient improves, the lactate will naturally come down.

The goal of my presentation wasn't to give all the answers—you can't do that in 15 minutes. My real aim was to provoke thought, to challenge assumptions, and to make people reconsider what they think they know.

If I've succeeded in raising awareness—if someone goes home questioning the lactate dogma, reading more, and exploring the topic for themselves—then I've done my job.

Now, people often ask: If lactate is protective, why is it so strongly correlated with mortality? And the answer is simple—correlation is not causation. Lactate is a marker of disease severity. The sicker you are, the more lactate your body produces. But it's not the lactate that's killing the patient—it's the severity of the underlying disease.

If you were to block lactate production in these critically ill patients, you'd likely see them deteriorate even faster. Because lactate is part of the adaptive response, not the problem itself.

Let me give you a comparison:

"Trump is stupid. Trump is American. That doesn't mean all Americans are stupid." It's an association, not a cause-and-effect relationship. The same applies to lactate and mortality.

So yes—I'm challenging conventional wisdom. Many clinicians are trained to believe that "A" is correct, and never even consider "B." These beliefs become dogma, almost religion, and when someone questions them, it creates discomfort.

But that discomfort is good. It means we're thinking. I'm not claiming to have all the answers—but I hope I've encouraged others to ask better questions, to challenge the status quo, and to see things from a different angle.

I am Tom Woodcock from UK and I was once told by a very well-known professor of anesthesia—someone you'll no doubt hear much more about in the coming decade—that patients die of sepsis because there's no starch left to plug the holes in their capillaries.

That statement stuck with me.

A few years ago, I decided to step away from clinical practice to fully focus on what I believe are three critical areas: law, ethics, and most importantly, fluid physiology. Why? Because as we're already discovering—on just the first half-day of this meeting—fluid physiology remains deeply misunderstood by both clinicians and physiologists. And as a result, patients are not benefiting from the level of expert care they deserve.

We're operating with almost no solid evidence to guide our practice. And that's unacceptable. We need to start making greater efforts, not just to understand the science, but to translate it into better outcomes for our patients.

This has been a long-standing interest of mine, one that I've pursued even more vigorously since stepping away from clinical work. And it's moments like when a colleague comes up to me and says, "I've been colloid for the last month or so"—and I see the smile on their face—that make it feel worthwhile.

The traditional way we teach doctors about fluid handling is deeply flawed. Countless observations from real patients in real hospitals have proven that much of the prevailing theory doesn't hold up in practice. Something needs to change.

Over the years, I've spent a great deal of time engaging with physiologists, and together we've tried to develop a more rational, predictive system for fluid prescribing—one that actually makes sense in real-world practice. But, as you might expect, it hasn't been widely accepted.

Why? Because many of us were taught that circulatory collapse is inevitable without albumin or colloid osmotic pressure. But that's simply not true. Unfortunately, those who have spent their careers teaching this flawed model are understandably reluctant to admit they may have been wrong.

That's why we need forums like this—where we can keep talking, and keep challenging assumptions. Not shouting or fighting, but talking, debating, evolving. Because eventually, something better will come out of it.

So, how do we distinguish a vein from an artery during ultrasound? This is crucial—because, of course, we do not want to puncture an artery. Generally:

• Veins appear oval on ultrasound and are usually compressible.

• Arteries are more round and non-compressible, maintaining their shape under pressure.

I am Willem Stockman from Belgium and today, I had the opportunity to give two talks:

1. One on ultrasound-guided vascular access, and

2. Another on transcranial Doppler (TCD)—a technique for assessing cerebral blood flow in critically ill patients.

My hope in delivering these talks is that clinicians who hear us speak about ultrasound will go back to their hospitals and start practicing it regularly. Especially with vascular access, ultrasound guidance can significantly improve patient safety by reducing complications during catheter placement.

When it comes to lung ultrasound, for a comprehensive exam—especially in complex settings like transplant patients—you'll typically need two types of probes: a linear and a convex.

As for transcranial Doppler, that's a bit more advanced. It's technically challenging, but incredibly valuable. I hope I was able to spark some interest among attendees—if even a few go back and implement TCD in their practice, that would be a meaningful step forward.

During the hands-on part, we scan extensively—recognizing structures like the ribs, pleural line, and identifying artifacts. You move the probe systematically: rib, rib, rib… scar… rib… scar—training your eye to catch subtle changes.

Of course, a course like this is meant as an introduction. After the lectures, participants practice on models, which are healthy and won't present pathology—but they're an excellent way to start building confidence with the ultrasound machine. It's the first step toward clinical mastery.

Hi, I am Ross Fisher from UK.

This is a heartfelt and highly relevant reflection on the importance of communication in medicine. Here's a polished and structured version of your transcript, capturing both the vulnerability and the power of your message, suitable for publication, a conference report, or a speaker spotlight:

As one of our colleagues rightly pointed out—we're terrified. And trust me, even speaking to just 30 of you, I'm experiencing sweaty palms, sweaty armpits, and tachycardia. It's anxiety-provoking—but also incredibly important.

The reason I'm here today is to run a presentation skills workshop—something I'm deeply passionate about, and something I believe is sorely missing from medical education.

There are so many brilliant minds in medicine, people with amazing ideas that could change the world. But too often, the way we communicate those ideas is poor, and as a result, the impact is lost. Ideas deserve to be heard, understood, and remembered—not just whispered and forgotten the moment the session ends.

That's why I encourage everyone to think critically about their presentation style and to take steps to improve it—so that the message lives on, long after the presentation is over.

And let's be clear: A great presentation takes time. As someone said earlier, you can write a presentation the night before—but it won't be excellent. Excellence requires effort, iteration, and intention.

This morning, I'm also here as part of the social media team, helping to amplify the message of this conference beyond the walls of the venue. More and more conferences are starting to see the value of social media in extending their reach. The goal is simple: to share the insights and energy of the event with the global medical community.

And today alone, through our social media efforts, we've already reached over 500,000 people. That's half a million individuals engaging with the ideas and conversations that started right here.

Sharing matters. Communication matters. Let's make our ideas not just heard—but remembered, repeated, and acted upon.

"Physiology is the only polar star we have." Luciano says it time and again—and he's absolutely right. So when it comes to fluid therapy, we need to begin by grounding ourselves in physiological principles.

I am Can Ince form The Netherlands and as a physiologist, that's my role—to focus on the mechanisms behind what we observe in the clinic. And I often find that clinicians are genuinely curious to hear from us: to understand which mechanisms are being affected, how they change in response to treatment, and why patients respond the way they do.

Let's ask the fundamental question: Why are you giving fluids?

• Is it to improve tissue oxygenation? Well, if there are no red blood cells, then there's no oxygen to carry—so that goal may not be met.

• Is it to correct acid–base balance? Perhaps—that's likely what the person who asked me to speak about buffers had in mind.

• Is it to restore or promote perfusion?

Or maybe it's all three.

This is why fluids are so central—and so controversial. Everyone uses them. But there are many types of fluids, and there's often little consensus on which to use, when, how much, or when to stop. Add to that the negative side effects of fluid overload, and it's easy to see why this topic triggers strong emotions—especially among anesthesiologists and intensive care physicians.

Fluids are one of the most routinely administered treatments in critical care, yet also one of the least consistently applied. That's why events like this conference are so valuable: they create space for meaningful, evidence-based debate.

Here's a critical example: When you administer large volumes of fluids, such as during cardiopulmonary bypass in cardiac surgery, you can end up diluting the blood so extensively that there's virtually no oxygen-carrying capacity left for a prolonged period. That's a dramatic physiological consequence, and it highlights why we must never treat fluids as neutral or benign. They are powerful interventions—and must be used with intention and precision.

So again, we come full circle: Physiology remains our guiding star. It must anchor every fluid decision we make.