Before we give fluids, we must first ask the right question: Could this patient potentially benefit from fluid administration? Perhaps they present with hypotension, tachycardia, or oliguria—or maybe a combination of these signs. But never should we give fluids just because “filling” appears low, or because cardiac filling pressures are low, or because echocardiography shows small cardiac chambers. No, no, no, no, no.

My name is Professor Jean-Louis Vincent, and I’m a Professor of Intensive Care Medicine at the University of Brussels. At this year’s IFAD meeting, I delivered two lectures.

The first focused on fluid management in severe respiratory failure, specifically in patients with ARDS. The second addressed the concept of fluid de-escalation—discussing when we should stop administering fluids, and in some cases, even remove excess fluid using diuretics or hemofiltration.

This congress is incredibly valuable because it raises the very questions we confront at the bedside every single day:

• What type of fluid should we give?

• How much is appropriate?

• When should we stop?

I’d like to extend my congratulations to our colleagues in Antwerp for organizing such an excellent and timely program. Everyone here is not only learning a great deal but also enjoying the opportunity to reconnect with colleagues, meet new people, and exchange ideas in a truly collaborative setting.

The social program has also been a highlight, allowing for informal interaction and meaningful conversations beyond the lecture hall.

This is a very important international congress, and I was pleased to hear from several attendees who said:

“It’s wonderful to have an entire symposium focused solely on intravenous fluids.” And I couldn't agree more.

About 1,800 years ago, we had the famous Solvay Conferences, attended by scientific giants like Einstein and Bohr. Today, at this congress, we’re privileged to share space with a new generation of international icons of science—contemporary leaders shaping the future of medicine.

My name is Dr. Dirk Himpe, and I’m an anesthesiologist at ZiekenhuisNetwerk Antwerpen (ZNA) Middelheim Hospital here in Antwerp.

What I’ve learned through experience—and what I continue to witness at events like this—is that life is all about balance. Too much is too much. Too little is too little. All living organisms strive to maintain a dynamic equilibrium between their internal environment and the world around them.

And that same principle applies to our medical therapies, especially fluids. As Paracelsus taught us in the Middle Ages,

"Only the dose makes the poison." Even something as essential as water can become toxic in excess. The components of intravenous fluids are no different: each one is vital to life, but overdosing any of them can lead to harm—or even death.

So the essence of it all—whether it’s drug therapy, fluid resuscitation, or broader clinical care—is balance. Equilibrium. That, in my view, is the core message of this congress.

This type of meeting is incredibly important, because we are witnessing a transition in medical science. As several speakers highlighted, we’re moving beyond small, tightly controlled studies with highly selected patients, and embracing large-scale epidemiological data that reflect real-life clinical practice. That’s how we will truly understand what works across diverse patient populations—and how we can improve outcomes in the real world.

And that, I believe, is the most important insight we’ve taken away from today.

We’re still working in somewhat of an evidence vacuum, but based on the available data, I continue to believe that there are circumstances where colloids remain necessary. Until I see compelling evidence that challenges long-standing clinical practice—practice that has delivered consistently good outcomes and is supported by numerous prospective randomized controlled trials—I won’t be convinced to change. When that evidence emerges, I’ll be happy to adapt, but for now, I still see a role for colloids.

My name is Professor Monty Mythen, and I’m a Professor of Anaesthesia and Critical Care at University College London. My lecture today focused on fluid restriction in the perioperative environment, exploring the important question: "How low can we go?" If we accept that fluid restriction may be in the patient’s best interest, we must determine just how far we can safely push that boundary.

This morning, I participated in two fantastic sessions. The second was a lively debate on the types of crystalloid solutions we use—specifically, the ongoing comparison between 0.9% sodium chloride (saline) and balanced solutions like Lactated Ringer’s or Hartmann’s.

While we had an insightful exchange, the takeaway was clear: there are no definitive clinical outcome studies that demonstrate a clear benefit for either solution. Pragmatically, balanced solutions still appear to be the sensible choice, but the field is awaiting more robust trial results before drawing final conclusions. So far, no benefit has been shown for 0.9% saline, but it remains an open question.

The IFAD conference is, in my view, the definitive international event on intravenous fluid therapy. It brings together leading experts and enthusiastic clinicians to discuss everything from types of fluids to fluid delivery strategies. The congress is exceptionally well-structured, and its engagement with social media and interactive elements place it at the very forefront of global critical care meetings. It’s a true privilege to be part of it.

My point is that crystalloids are excellent—when used appropriately. They are especially effective in situations of hypovolemia, low arterial pressure, and low hydrostatic pressure. In these cases, crystalloids can be life-saving.

My name is Professor Robert Hahn, and I’m from Stockholm, Sweden. This is my third time attending the IFAD meeting, and it’s a pleasure to be here again.

In my talk today, I emphasized that crystalloids are effective for managing hypovolemic shock. On the other hand, I presented the view that colloid preloading before surgery has very limited value, with the possible exception of obstetrics.

Finally, I addressed a common misconception by challenging some of the older studies suggesting damage to the glycocalyx in hypovolemic states. I believe that several of these studies are methodologically flawed or have been misinterpreted.

I think IFAD is a truly special meeting. It has succeeded in bringing together world leaders in fluid therapy, creating an impressive and diverse faculty. Historically, fluid therapy has been guided more by personal experience and clinical intuition than by evidence. It’s only in the last 15 years that we've seen the emergence of a strong scientific foundation—and that foundation is growing rapidly.

What makes IFAD unique is that it provides dedicated space for a topic that is too often overlooked at other meetings. The decision to devote an entire congress to fluid therapy is not only well-founded—it’s critically important. I sincerely wish the meeting continued success in the years to come.

Again, what we see is that very low or very high values—when extreme enough—can sometimes offer predictive value. It’s in the extremes that we occasionally find meaningful guidance.

My name is Professor Anders Perner, and I’m based at Copenhagen University Hospital in Denmark. At this year’s IFAD meeting, I participated in a Pro/Con debate on the use of central venous pressure (CVP) monitoring, where I presented the argument in favor of CVP.

I believe the IFAD Congress is an outstanding opportunity to engage with colleagues, friends, and experts from around the world and to have focused, high-level discussions on one of the most critical aspects of intensive care: fluid therapy.

In many ways, this meeting has found the perfect balance—its size, its focus, and the setting all contribute to creating an ideal environment for sharing ideas, challenging assumptions, and improving the care of our sickest patients.

We live in a time where we have so many tools and parameters to measure, and we must use this information to decide on the best therapy for our patients. As Professor Lichtenstein points out in his book, there are indeed a multitude of variables, but in the end, it often comes down to just three key choices.

My name is Dr. Paul Elbers, and I’m an intensivist at VU University Medical Center in Amsterdam.

My talk at IFAD focuses on how to consolidate ultrasound into your ICU practice. After completing a basic ultrasound course, many clinicians find that not everyone in their institution agrees they are qualified to use it independently. That’s why I strongly advocate for formal certification—not only to validate your skills, but also to avoid legal or professional complications down the line.

This is my fifth time attending IFAD in Antwerp, and I want to extend my congratulations to Dr. Van Regenmortel and Dr. Manu Malbrain for consistently organizing such a high-level, engaging congress. Ultrasound and fluid therapy remain hot topics in critical care, and I’m confident they will continue to be for years to come.

I’m already looking forward to the sixth edition of IFAD.

Until now, I’ve noticed that the topic of anemia—and the oxygen-carrying capacity of the blood—has not been mentioned much. We’ve heard discussions on hypovolemia, fluid overload, and volume status, but anemia, which directly impacts oxygen delivery, seems to be underrepresented in the conversation.

My name is Professor Can Ince, and I’m a physiologist, not a clinician. I have the pleasure of giving two lectures at this year’s congress.

The first is on the glycocalyx—a crucial component of the endothelial surface layer that lines blood vessels. The glycocalyx plays a central role in maintaining vascular integrity, and I’ll be discussing its involvement in the pathogenesis of sepsis and shock.

My second session is a Pro/Con debate with Professor Anders Perner on the use of blood transfusions. I’ll be arguing in favor of transfusing blood, emphasizing that blood—unlike fluids—is the body’s primary oxygen carrier, and restoring oxygen delivery is often more important than just increasing volume.

As for the conference itself, I’ve had the honor of attending since the very beginning, and I’m truly grateful to be invited back each year. Even as a non-clinician, I find this meeting immensely valuable. It’s one of the few forums that successfully integrates fluid therapy with hemodynamic support into a unified, physiologically grounded concept.

This approach is exactly what we need to optimize fluid use in perioperative and critical care. Each year, I see growing enthusiasm and engagement from colleagues across Europe, and that is a testament to the vision and commitment behind this event.

So, well done Manu—and I sincerely hope that the IFAD Congress continues to thrive for many years to come.

It appears that albumin therapy may offer advantages, particularly when used early in patients with mild to moderate hypoalbuminemia.

My name is Professor Luciano Gattinoni, and I’m presenting on three topics at this year’s congress:

1. The use of albumin in intensive care

2. The treatment of Acute Respiratory Distress Syndrome (ARDS)

3. And finally, a session of closing reflections on the future of intensive care—where we might be headed in the coming years.

What makes this congress especially meaningful, in my view, is its unique character. Unlike many other conferences that tend to present fixed narratives or so-called truths, this meeting fosters a true dialogue. It’s a place where evidence-based medicine is constantly placed in constructive tension with physiology, which remains the foundational science of our discipline.

This dialectical approach—thinking and rethinking reality—sets it apart. Here, nothing is taken for granted, and discussions are rich with doubt, nuance, and learning. Sometimes, you hear something you've heard three times before, and only on the fourth time, the light finally switches on.

That’s the true value of a congress like this. Not just to receive information, but to engage with it, challenge it, and grow from it.

In this study, as you can see, there is a clear signal in favor of patients who received colloids during their resuscitation in the ICU.

My name is Prof. Karim Asehnoune, and I am a Professor of Anesthesiology and Critical Care Medicine at the University Hospital of Nantes in France, where I work in the surgical intensive care unit.

My lecture focused on the therapeutic potential of starch-based colloids, particularly in severe trauma and massive hemorrhage (MRH) patients. While these molecules are no longer permitted in the treatment of septic shock, there is still an active debate regarding their possible role in hemorrhagic shock and trauma resuscitation. My aim was to present the current evidence and stimulate further discussion on their use in these specific contexts.

This is my first time attending the IFAD Congress, and I must say—it has been an excellent experience. The meeting is particularly relevant because fluid therapy remains a cornerstone of ICU management, yet we now recognize that it can also contribute to morbidity if not administered judiciously.

What makes IFAD stand out is its dedicated focus on fluids—including fluid therapy, fluid challenges, and how to guide fluid administration using hemodynamic data. These are essential topics for intensivists and anesthesiologists alike.

I’m very happy to be part of this event, and I truly believe IFAD has become a major international congress in Europe, bringing together experts and thought leaders to address one of the most critical aspects of intensive care.

I am Dileep Lobo from UK. Before we began the debate, I posed a question to the audience: "How many of you would consider giving your patient a drug that wouldn’t even pass a Phase 1 clinical trial?" That question set the tone for the discussion.

Today, I gave two lectures. The first was a debate on 0.9% saline versus balanced crystalloids, in which I argued in favor of balanced crystalloids as the superior option. I’m pleased to share that by the end of the session, we won the audience vote—a great sign that the evidence and arguments resonated.

I believe the IFAD Congress has truly evolved over the years. I’ve been attending for the past three editions, and with each one, the program gets even stronger. We’re treated to state-of-the-art lectures by world-renowned experts, and the interactive discussions allow for healthy debate around current evidence, giving the audience the opportunity to form their own informed opinions.

What also stands out is the congress's commitment to forward-looking insights—highlighting not only where we are today but also where the field of fluid therapy and critical care is heading.

As with previous years, I’ve thoroughly enjoyed this conference, and I look forward to seeing how it continues to grow.