European Society of Intensive Care Medicine Clinical Practice Guideline on fluid therapy in adult critically ill patients: A path toward improved patient management

Fluid therapy is a key component in the management of critically ill patients.For a given patient, many aspects must be considered from selection of fluid type for the determination of the optimal amount and timing of administration.Additionally, one may have to discuss the potential benefit of active fluid withdrawal once circulatory failure is under control.The European Society of Intensive Care Medicine (ESICM) recently published clinical practice guidelines on fluid therapy covering these different aspects.[1][2][3] We will highlight the essential points and discuss the strengths and weaknesses of the recommendations in this manuscript ( Table 1 ).The scope of the guidelines was resuscitation fluid therapy in adults and covered the choice of resuscitation fluid, [ 1 ] the volume of resuscitation fluids, [ 2 ] and fluid removal at de-escalation phase.[ 3 ] The panel consisted of 49 members separated into three working groups to cover the three parts of the guidelines.There were two ESICM Guidelines overall Co-chairs (one Clinical Content co-chair and one Methodology co-chair), and each working group had one Clinical Chair and one or two Methodology Co-Chair(s).The panel was appointed considering diversity and inclusivity, covering all continents, and included clinicians, specialized in critical care, anesthesia, infectious diseases, nephrology, and emergency medicine as well as critical care nursing.Additionally, one patient representative was invited to participate.To address the PICO (Population, Intervention, Comparator, and Outcome) questions determined by each working group; a systematic search was performed focusing on randomized clinical trials (RCTs) conducted in critically ill patients.Evidence was aggregated and the panel used consensus to formulate the final recommendations based on GRADE's recommendations.