The debate on fluid management and haemodynamic monitoring continues: between Scylla and Charybdis, or faith and evidence…
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Manu L.N.G. Malbrain, Niels Van Regenmortel, Radosław OwczukAbstract/Text
We are very excited to present to you this issue of “Anaesthesiology and Intensive Therapy” (AIT) containing the Proceedings of the Fourth International Fluid Academy Days (iFAD) with some excellent reviews from internationally renowned experts in their field!
This 4th iFAD will deliver once more a compact two-day programme on clinical fluid management, a topic that has been neglected for a long time, and haemodynamic monitoring. Although the medical community clearly seems to understand the importance of looking at fluids beyond their role for mere haemodynamic stabilisation, we should treat fluids like any other drug we give to our patients [1, 2]. The side effects of fluids are without doubt more than relevant, and there is increasing evidence that the development of hyperchloremic metabolic acidosis due to the use of unbalanced solutions is not as innocent as previously thought [3−5]. Langer et al. [6] nicely illustrate in their review on the effects of intravenous solutions on acid-base equilibrium that the knowledge of the composition of intravenous fluids, along with the application of simple physicochemical rules best described by Stewart’s approach, are pivotal steps towards fully elucidating and predicting alterations of plasma acid-base equilibrium induced by fluid therapy [6].
Fluids have indications and contraindications and indeed potential side-effects, and as such the best fluid is probably the one that has not been given to the patient. As Paracelsus nicely put it, it is the dose that makes the poison, and no less is true when it comes to fluid management in the critically ill: it is all about the type of fluids, the dose, the timing, and the speed of administration.
As a result, the International Fluid Academy (IFA, www.fluid-academy.org) was founded in 2011 to serve as a platform on which to gather experts in the field and to organise meetings, workshops and teaching courses. The IFA is part of iMERiT (the International Medical Education and Research Initiative, a non-profit organisation based in Belgium). The mission statement of the IFA is to foster education, promote research on fluid management and haemodynamic monitoring, and thereby improve survival of the critically ill by bringing together physicians, nurses, and others from throughout the world and from a variety of clinical disciplines.