• Privacy GDPR

    Privacy Policy

    The European General Data Protection Regulation (GDPR) comes into force on May 25th 2018 and has major implications worldwide. European citizens now have multiple digital rights over their personal details, including the right to be asked to provide consent for the storage of personal details in a database, the right to be asked to provide consent to be contacted, the right to see the personal information stored, the right to be forgotten including having all personal details permanently removed from a database, the right to know who this information is shared with (consent is also required for this), and the right to be contacted should a significant data breach occur. All of these changes must be prospectively acknowledged by the user and cannot be presumed to have occurred. The proof rests with the websites to be able to demonstrate consent has been obtained. It is likely almost all websites in the world will move to this model, unless they wish to limit access to European citizens, which would be difficult technically. Fines for non-compliance with this can reach €20 million. As a result, we have updated our privacy policy accordingly. We took as example the updated privacy policy of Critical Care Reviews, a sister website providing FOAM content...

  • 7th IFAD 2018

    FIRST BATCH OF EARLY BIRD ONLINE REGISTRATIONS SOON OPEN

    November 23rd 2018
    Congress Centre "Pakhuis De Zwijger", Amsterdam, The Netherlands

    We are very pleased to announce the 7th International Fluid Academy Day, which will take place on November 23rd 2018 at Pakhuis De Zwijger in Amsterdam, The Netherlands. The aim of this seventh edition is again to review recent advances in fluid management, and hemodynamic and organ function monitoring in the critical care setting in a comprehensive manner for intensivists, anaesthesiologists and emergency physicians as well as interested internists and surgeons. However the meeting will deal with any broad topic related to critical care. As always it is also a great way to promote professional interaction between faculty members, participants and delegates of the industry. This website is regularly updated. Last modification by Adminstrator (Manu Malbrain) on February 7th at 10:00 AM.

  • About iFAD

    The iFAD started as local initiative form the pharmaceutical working group on fluids from the Ziekenhuis Netwerk Antwerpen (www.zna.be). Today iFAD is integrated within the not-for-profit charitable organization iMERiT, International Medical Education and Research Initiative, under Belgian law and as such the iFAD Organising Committee strongly recognizes and values a constructive partnership with the industry.

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  • Brand new website!

    The IFAD website content is based on the philosophy of FOAM (Free Open Access Medical education – #FOAMed). The organising committee gives their time freely and receives no financial benefit. This in part explains the wonderful passions for philanthropy, sharing, education and innovation that make the IFAD unique.

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  • Free Open Access Medical Education and Member Benefits

    The International Fluid Academy adheres to the FOAM principles for all website visitors: FREE Open Access Medical Education (#FOAMed #FOAMcc #FOAMus).

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    We are very pleased to announce the 7th International Fluid Academy Day, which will take place on November 23rd 2018 at Pakhuis De Zwijger in Amsterdam, The Netherlands. The aim of this seventh edition is again to review recent advances in fluid management, and hemodynamic and organ function monitoring in the critical care setting in a comprehensive manner for intensivists, anaesthesiologists and emergency physicians as well as interested internists and surgeons. However the meeting will deal with any broad topic related to critical care. As always it is also a great way to promote professional interaction between faculty members, participants and delegates of the industry.

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The four questions of fluid therapy (Part 1.4.)

The four questions of fluid therapy (Part 1.4.)

Part 1.4. of series on fluid therapy

Why should I bother about the ebb and flow phase of shock? An illustrative case report

Multiple choice question 3

At this stage, the participants of the ISICEM and IFAD meetings were asked the third multiple choice question (MCQ3): “What is the premature hump that appeared on the transpulmonary thermodilution curve?”. Possible answers were: 1) Nothing to worry about, it is just an example of the crosstalk phenomenon; 2) It is related to thermal bolus mixing; 3) It may be an indicator of a right-to-left shunt due to pulmonary hypertension; 4) It is related to a wrong or false measurement technique; or 5) I don't know. Figure 9 shows the results of three votings.

Fig9
Figure 9. Multiple choice question 3 (MCQ3): “What is the premature hump that appeared on the transpulmonary thermodilution curve?". Distribution of answers (in percentage) on MCQ3, blue squares denote the voting results of the ISICEM 2012 meeting, red squares show the results of the iFAD 2012 meeting, and green squares denote the voting results of the ISICEM 2013 meeting.

The premature hump is evidence for a right to left shunt where an opening (foramen ovale) appears between the right and left atria. About half of the participants (41 to 61%) indicated the correct answer. Because the patient was extremely hypovolemic, the combination of positive pressure ventilation with high PEEP led to increased pulmonary vascular resistances, pulmonary hypertension and a propagation of West zone 1 conditions to zones 2 and 3. This phenomenon has been documented before [29, 30].

Further course

By late afternoon of day 2, the patient had had a drop in urine output with production of only 350 mls over the last 12 hours despite a positive cumulative fluid balance of 4 litres. He was still on dobutamine 5 ug/kg/min, and norepinephrine 0.2 ug/kg/min. Other parameters are listed in Tables 2 and 3, and can be summarized as follows: CI 5.4 L/min.m2, MAP 79 mmHg, CVP 8 mmHg, PPV 6 %, GEF 23 %, GEDVI 1080 ml/m2, EVLWI 18 ml/kg PBW, conclusive with overfilling and worsening pulmonary edema in the absence of fluid responsiveness. Respiratory function deteriorated with a P/F ratio of 205, at an IPAP of 34 cmH2O, PEEP 11 cmH2O, while FiO2 was increased from 45 to 65%. Lactate levels increased from 1.6 to 2.6 mmol/L

Multiple choice question 4

At this stage, the participants of the ISICEM and IFAD meetings were asked the fourth multiple choice question (MCQ4): “Taking into account the new results obtained with the transpulmonary thermodilution and the drop in urine output, what is your treatment of choice at this stage?” Possible answers were:
1) norepinephrine
2) dobutamine
3) fluid bolus
4) diuretics
5) other

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