One of the major challenges we face is the assumption that patients fully recover from acute kidney injury (AKI) through regeneration of the tubular epithelium, with a return to normal renal function. However, it’s actually quite easy for this repair process to shift toward fibrosis, ultimately leading to the development of chronic kidney disease (CKD).

My name is Dr. John Prowle, and I’m a Senior Lecturer and Consultant Intensivist and Nephrologist based in London.

Today, my talk focuses on the use of renal replacement therapy (RRT) in the ICU, exploring the different modalities available and how they relate to our central theme of fluid management. Specifically, I’ll discuss how different forms of RRT can be utilized for the resolution of fluid overload, a key issue in critically ill patients.

This congress offers a fantastic opportunity for clinicians who are passionate about understanding both the benefits and risks of fluid therapy to come together, share expertise, and develop a collaborative approach to guide future research in this vital area of critical care.

First of all, I’d like to explore why it’s so important to optimize ventilator settings in our ICU patients.

My name is Prof. Diederik Gommers, and I’m based in Rotterdam, the Netherlands, where I serve as Head of the Intensive Care Department and Professor of Intensive Care Medicine. My research specialization is in mechanical ventilation.

In my lecture, I will discuss strategies for optimal ventilator settings, focusing in particular on NAVA (Neurally Adjusted Ventilatory Assist) and the use of electrical impedance tomography (EIT)—two innovative tools that help tailor respiratory support to each patient's individual needs.

I think this is a very well-organized congress, and the focus on fluids and fluid choice is especially relevant—these are core elements of our daily clinical practice in the ICU. It’s great to see such a strong international faculty and a high-quality scientific program, which makes this event both educational and inspiring.

I’m here to introduce our host and chairman, Dr. Manu Malbrain.

Dr. Manu Malbrain: Thank you, Monty. Thank you, Dirk. And welcome, everyone.

This meeting originally started in our hospital in collaboration with the ZiekenhuisNetwerk Antwerpen (ZNA) in Antwerp, Belgium. We’re proud to say that this is now the fifth edition of the International Fluid Academy Days (IFAD), and a lot has changed since our first event in 2011.

Over the years, we’ve come to understand that fluids should be treated as drugs—just like any other medication we administer to patients. That means considering not only the type of fluid, but also the dose, volume, rate of administration, duration, and most importantly, recognizing when to stop fluid therapy once it is no longer beneficial.

Today, I participated in a Pro/Con debate on cardiac output monitoring, where I argued in favor of routine monitoring. I firmly believe that cardiac output assessment should be a standard part of the physiological examination. After all, cardiac output is central to the definition of shock, which is the imbalance between oxygen delivery and oxygen consumption. If we aim to manage shock effectively, then we must monitor cardiac output appropriately.

What makes the Fluid Academy Days unique is that it remains the only dedicated congress focusing entirely on fluids, monitoring, and organ function. It brings together specialists and leading experts from around the globe to explore, debate, and find answers to some of the most pressing questions in critical care medicine.

What I’d like to do over the next 15 minutes is to give you a brief overview of the history and rationale behind the development of balanced solutions.

My name is Dr. Pietro Caioni, and I’m an intensivist working in an ICU in Milan, Italy.

In my presentation, I focused on two key aspects:

1. The impact of balanced solutions on acid-base equilibrium—a critical factor in maintaining physiological stability in critically ill patients.

2. More recently, the role of balanced solutions in minimizing fluctuations in chloride levels, which has become a central aim of fluid therapy as we recognize the harmful effects of hyperchloremia on kidney function and overall patient outcomes.

I believe this is a fantastic event—exceptionally well organized with a rich and relevant scientific program. The organizers have done an excellent job bringing together many of the leading experts in fluid therapy, which, in my opinion, is one of the most crucial aspects of daily clinical practice in intensive care.

How many of you have a formal echocardiography or ultrasound training program in your institution?

My name is Dr. Adrian Wong, and I’m a Consultant in Intensive Care Medicine at Oxford University Hospitals NHS Trust in the UK. I’m delighted to be giving a couple of talks at this year’s IFAD meeting.

I’ll first be taking part in the ultrasound debate. Although I’m personally a strong believer in ultrasound, I’ve been asked to argue the "against" position—challenging the use of ultrasound as a routine monitoring tool in the ICU. It should spark an engaging and thought-provoking discussion.

Later, I’ll be giving a lecture on ultrasound training, where I’ll share insights from our own fellowship and accreditation programs in the UK. My goal is to exchange ideas and collaborate with colleagues from around the world—learning from their experiences and hopefully offering useful takeaways from ours.

During the hands-on course yesterday, I had the privilege of teaching a truly motivated group of colleagues who were eager to develop their point-of-care ultrasound (POCUS) skills. At one point, I said, “If I get you to roll over to your left-hand side, it means your colleague can see a bit better.” That’s because positioning the patient in the left lateral decubitus position brings the heart more anterior and helps push the lung out of the way, making views like the parasternal long axis much easier to obtain.

I strongly believe that POCUS enhances our clinical practice. It complements and sharpens our bedside examination skills, making us better, more informed clinicians. But, as I discussed with several colleagues yesterday, access to formal training in ultrasound remains patchy across institutions.

That’s why courses like the one held here are so valuable. They provide a rare opportunity to share, collaborate, and learn together, especially when we have the chance to learn from true masters of POCUS. Everyone benefits from that collective expertise.

The IFAD Congress is, in my opinion, a critically important event. Fluid management touches every aspect of medicine—from intensive care to anesthesia and resuscitation. It’s what we do daily, and yet, there’s still so much uncertainty and so little consensus about the best approaches.

That’s why gatherings like this matter. It’s only through open discussion, knowledge exchange, and shared experience that we can advance our practice and ultimately improve patient care.

How many of you have ever used this—before measuring the CVP (central venous pressure)? It’s a question that highlights the variability in how we approach fluid therapy at the bedside.

My name is Professor Daniel Reuter, and I’m based in Hamburg, Germany. I was invited to speak about the role of CVP monitoring in guiding fluid therapy, a topic that continues to generate discussion and debate in critical care. Tomorrow, I’ll also be giving a lecture on monitoring strategies for managing patients with ARDS, another complex and evolving area in intensive care medicine.

What makes this congress truly unique is the familiar, interactive atmosphere. Unlike many larger meetings where interaction is limited, here we experience excellent engagement between speakers and participants. Attendees don’t hesitate to ask questions, approach speakers during breaks, and initiate thoughtful discussions.

For us as faculty, this is incredibly valuable—not only to receive feedback on the ideas and data we present, but also to learn how things are handled in different countries and clinical settings. These conversations give us a broader perspective on how evidence is translated into practice across diverse healthcare environments.

It’s that exchange of knowledge and real-world experience that makes this event so rewarding—not just for participants, but for speakers as well.

That’s the challenge—we need to define and target specific hemodynamic goals. But the question remains: Can we truly find one hemodynamic target that fits everyone—you, her, him, and me?

I’m Professor Azriel Perel from Tel Aviv, and I just participated in a pro/con debate on goal-directed therapy (GDT). While GDT is gaining popularity, it’s important to recognize that it often means different things to different people. The term is frequently used, but not always clearly defined.

In my presentation, I addressed the pathophysiological rationale behind this approach, and I also challenged some of the so-called supporting evidence. We must be cautious in clinical practice—not everything labeled as “evidence-based” is necessarily solid or universally applicable. It’s essential that we remain critical thinkers, especially when integrating new protocols into patient care.

To be honest, I always start to sweat a little when I hear the word “goal”—because in a way, I’ve been practicing goal-directed therapy my entire career. But goals should be individualized, and we must acknowledge the complexity and variability among patients.

This is my fifth time attending IFAD, and once again, it’s a true pleasure. What I find both amazing and a bit ironic is that even after all these years, we’re still not any closer to full agreement. New data keep emerging, but the interpretation of these data remains challenging—sparking lively, sometimes heated debates, which are as educational as they are entertaining.

Thank you, Manu, for organizing yet another thought-provoking and enjoyable congress.

As you can see in this picture, I completed a one-year research fellowship at the University of California, Irvine, where I had the privilege of being mentored by Prof. Maxime Cannesson.

My name is Dr. Alexandre Joosten, and I’m an anesthesiologist in the Department of Anesthesiology and Perioperative Care at Erasmus Hospital in Brussels.

Today, I had the opportunity to give two lectures. The first focused on perioperative goal-directed therapy (GDT), specifically addressing how fundamental concepts related to fluid management and hemodynamic optimization can significantly improve outcomes in high-risk surgical patients.

In the afternoon, I delivered a second presentation on the same topic as part of a satellite symposium sponsored by Edwards Lifesciences. This session placed special emphasis on practical implementation at the bedside—highlighting how technology-assisted approaches, including automated systems and closed-loop algorithms, can support clinicians in applying GDT more effectively.

This is my first time attending this congress, and I’ve thoroughly enjoyed the experience. The event brings together many well-known experts in the field, and I’ve had the chance to learn a great deal. It’s truly a pleasure and privilege to be part of this vibrant and insightful community.

As Hippocrates once said—a sad and unfortunate truism—“He who wants to learn the art of surgery must go to war.” And that’s essentially what the Guinea Pig Club represented.

I’m Professor David Muckart from South Africa, and my lecture focused on the Guinea Pig Club, a remarkable group of injured aircrew from World War II, many of whom were fighter pilots who sustained severe burns during combat.

At that time, medical and surgical teams had no real experience or understanding of how to treat such devastating injuries. So they explained to the injured airmen, frankly: “We’re going to have to experiment.” In response, the aircrew humorously but poignantly said, “Well, if we’re the ones being experimented on, then we’re the guinea pigs.” Hence, the Guinea Pig Club was born—a powerful symbol of both medical innovation and the human spirit in the face of adversity.

This congress is critically important. Fluid management remains one of the most debated and controversial topics in intensive care. Even among the most experienced intensivists, there are divergent views—and that’s exactly why gatherings like this are essential. We need to come together, share knowledge, and work toward a consensus on what’s truly best for our patients.

It’s also inspiring to see so many young professionals attending. They are the future of intensive care, and their enthusiasm and engagement are vital for advancing our field.

As for me—well, I’m hoping not to be around in intensive care for too much longer! But it’s reassuring to know the next generation is stepping up with such passion and curiosity.

I’m Jeffrey Schouten from Belgium and genuinely excited to see that a congress focused on emergency and intensive care medicine is placing such a strong emphasis on ultrasound. To me, ultrasound is truly the stethoscope of the modern physician—an essential tool for bedside diagnosis and decision-making.

That’s why I believe it’s so important to have dedicated discussions and sessions on ultrasound at a congress like this. It reflects how far we’ve come in integrating this technology into everyday clinical practice, and it’s a critical step in ensuring all healthcare professionals are empowered to use it effectively.