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Objective <p>This European Society of Intensive Care Medicine (ESICM) guideline provides evidence-based recommendations on the volume of early resuscitation fluid for adult critically ill patients.</p> Methods <p>An international panel of experts developed the guideline, focusing on fluid resuscitation volume in adult critically ill patients with circulatory failure. Using the PICO format, questions were formulated, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations.</p> Results <p>In adults with sepsis or septic shock, the guideline suggests administering up to 30 ml/kg of intravenous crystalloids in the initial phase, with adjustments based on clinical context and frequent reassessments (very low certainty of evidence). We suggest using an individualized approach in the optimization phase (very low certainty of evidence). No recommendation could be made for or against restrictive or liberal fluid strategies in the optimization phase (moderate certainty of no effect). For hemorrhagic shock, a restrictive fluid strategy is suggested after blunt trauma (moderate certainty) and penetrating trauma (low certainty), with fluid administration for non-traumatic hemorrhagic shock guided by hemodynamic and biochemical parameters (ungraded best practice). For circulatory failure due to left-sided cardiogenic shock, fluid resuscitation as the primary treatment is not recommended. Fluids should be administered cautiously for cardiac tamponade until definitive treatment and guided by surrogate markers of right heart congestion in acute pulmonary embolism (ungraded best practice). No recommendation could be made for circulatory failure associated with acute respiratory distress syndrome.</p> Conclusions <p>The panel made four conditional recommendations and four ungraded best practice statements. No recommendations were made for two questions. Knowledge gaps were identified, and suggestions for future research were provided.</p>

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European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids

  • 期刊论文

  • 发表日期：

    2025年3月31日

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  • Armand Mekontso Dessap,
  • Fayez AlShamsi,
  • Alessandro Belletti,
  • Daniel De Backer,
  • Anthony Delaney,
  • Morten Hylander Møller,
  • Segolène Gendreau,
  • Glenn Hernandez,
  • Flavia R. Machado,
  • Mervyn Mer,
  • Manuel Ignacio Monge Garcia,
  • Sheila Nainan Myatra,
  • Zhiyong Peng,
  • Anders Perner,
  • Michael R. Pinsky,
  • Sameer Sharif,
  • Jean-Louis Teboul,
  • Antoine Vieillard-Baron,
  • Waleed Alhazzani,
  • Daniel De Backer,
  • Morten Hylander Møller,
  • Yaseen M. Arabi,
  • Fayez Alshamsi,
  • Emilie Belley-Cote,
  • Andrea Carsetti,
  • Alessandro Protti,
  • Katia Donadello,
  • Nicole Juffermans,
  • Naomi Hammond,
  • Jon Henrik Laake,
  • Dawei Liu,
  • Kathryn Maitland,
  • Antonio Messina,
  • Rob Mac Sweeney,
  • Jean-Louis Vincent,
  • Fernando Zampieri,
  • Daniele Poole,
  • Armand Mekontso-Dessap,
  • Waleed Alhazzani,
  • Fayez Alshamsi,
  • Alessandro Belletti,
  • Anthony Delaney,
  • Glen Hernandez,
  • Flavia R. Machado,
  • Manuel Ignacio Monge García,
  • Mervin Mer,
  • Sheila Nainan Myatra,
  • Michael R. Pinsky,
  • Anders Perner,
  • Zhiyong Peng,
  • Sameer Sharif,
  • Jean-Louis Teboul,
  • Antoine Vieillard-Baron,
  • Ségolène Gendreau,
  • Marlies Osterman,
  • Antonio Artigas Raventós,
  • Ichai Carole,
  • Maurizio Cecconi,
  • Christina Jones,
  • Xavier Monnet,
  • Manu Malbrain,
  • Marek Nalos,
  • Zhiyong Peng,
  • Carmen Pfortmueller,
  • John Prowle,
  • Otavio Ranzani,
  • Manu Shankar-Hari Adrian Wong,
  • Carl Thomas Anthon,
  • Anders Granholm

摘要

Objective

This European Society of Intensive Care Medicine (ESICM) guideline provides evidence-based recommendations on the volume of early resuscitation fluid for adult critically ill patients.

Methods

An international panel of experts developed the guideline, focusing on fluid resuscitation volume in adult critically ill patients with circulatory failure. Using the PICO format, questions were formulated, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations.

Results

In adults with sepsis or septic shock, the guideline suggests administering up to 30 ml/kg of intravenous crystalloids in the initial phase, with adjustments based on clinical context and frequent reassessments (very low certainty of evidence). We suggest using an individualized approach in the optimization phase (very low certainty of evidence). No recommendation could be made for or against restrictive or liberal fluid strategies in the optimization phase (moderate certainty of no effect). For hemorrhagic shock, a restrictive fluid strategy is suggested after blunt trauma (moderate certainty) and penetrating trauma (low certainty), with fluid administration for non-traumatic hemorrhagic shock guided by hemodynamic and biochemical parameters (ungraded best practice). For circulatory failure due to left-sided cardiogenic shock, fluid resuscitation as the primary treatment is not recommended. Fluids should be administered cautiously for cardiac tamponade until definitive treatment and guided by surrogate markers of right heart congestion in acute pulmonary embolism (ungraded best practice). No recommendation could be made for circulatory failure associated with acute respiratory distress syndrome.

Conclusions

The panel made four conditional recommendations and four ungraded best practice statements. No recommendations were made for two questions. Knowledge gaps were identified, and suggestions for future research were provided.