European Society of Intensive Care Medicine clinical practice guideline on fluid therapy in adult critically ill patients. Part 1: the choice of resuscitation fluids

Yaseen M. Arabi*, Emilie Belley-Cote, Andrea Carsetti, Daniel De Backer, Katia Donadello, Nicole P. Juffermans, Naomi Hammond, Jon Henrik Laake, Dawei Liu, Kathryn Maitland, Antonio Messina, Morten Hylander Møller, Daniele Poole, European Society of Intensive Care Medicine

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Purpose:
This is the first of three parts of the clinical practice guideline from the European Society of Intensive Care Medicine (ESICM) on resuscitation fluids in adult critically ill patients. This part addresses fluid choice and the other two will separately address fluid amount and fluid removal.

Methods:
This guideline was formulated by an international panel of clinical experts and methodologists. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology was applied to evaluate the certainty of evidence and to move from evidence to decision.

Results:
For volume expansion, the guideline provides conditional recommendations for using crystalloids rather than albumin in critically ill patients in general (moderate certainty of evidence), in patients with sepsis (moderate certainty of evidence), in patients with acute respiratory failure (very low certainty of evidence) and in patients in the perioperative period and patients at risk for bleeding (very low certainty of evidence). There is a conditional recommendation for using isotonic saline rather than albumin in patients with traumatic brain injury (very low certainty of evidence). There is a conditional recommendation for using albumin rather than crystalloids in patients with cirrhosis (very low certainty of evidence). The guideline provides conditional recommendations for using balanced crystalloids rather than isotonic saline in critically ill patients in general (low certainty of evidence), in patients with sepsis (low certainty of evidence) and in patients with kidney injury (very low certainty of evidence). There is a conditional recommendation for using isotonic saline rather than balanced crystalloids in patients with traumatic brain injury (very low certainty of evidence). There is a conditional recommendation for using isotonic crystalloids rather than small-volume hypertonic crystalloids in critically ill patients in general (very low certainty of evidence).

Conclusions:
This guideline provides eleven recommendations to inform clinicians on resuscitation fluid choice in critically ill patients.

Original languageEnglish
Pages (from-to)813-831
Number of pages19
JournalIntensive Care Medicine
Volume50
Issue number6
Early online date21 May 2024
DOIs
Publication statusPublished - Jun 2024

Bibliographical note

Publisher Copyright:
© Springer-Verlag GmbH Germany, part of Springer Nature 2024.

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