Choice of resuscitation fluids in critically ill adults: key messages from the European Society of Intensive Care Medicine 2024 clinical practice guidelines.
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Clinical Guidelines
Authored By
Alshamsi F, Alhazzani W
Authored On
Interests
Emergency Medicine
Speciality
Emergency Medicine
Book Detail
volume
135
ISSN
1897-9483
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["Alshamsi F, Alhazzani W","Publisher: Medycyna Praktyczna Country of Publication: Poland NLM ID: 101700960 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1897-9483 (Electronic) Linking ISSN: 00323772 NLM ISO Abbreviation: Pol Arch Intern Med Subsets: MEDLINE","Journal Article; Review","2025-02-27","Polish archives of internal medicine [Pol Arch Intern Med] 2025 Feb 27; Vol. 135 (2). Date of Electronic Publication: 2025 Jan 28.","English","1897-9483","Fluid Therapy*\/methods , Fluid Therapy*\/standards , Critical Illness*\/therapy , Critical Care*\/standards , Resuscitation*\/methods , Resuscitation*\/standards , Practice Guidelines as Topic*, Humans ; Crystalloid Solutions\/therapeutic use ; Europe ; Adult ; Albumins\/therapeutic use ; Societies, Medical","Humans, Crystalloid Solutions therapeutic use, Europe, Adult, Albumins therapeutic use, Societies, Medical, Fluid Therapy methods, Fluid Therapy standards, Critical Illness therapy, Critical Care standards, Resuscitation methods, Resuscitation standards, Practice Guidelines as Topic","Polish archives of internal medicine","135"]
Description
The 2024 European Society of Intensive Care Medicine clinical practice guideline provide clinicians with evidence-based recommendations on intravenous fluid in critically ill adults across a range of common conditions. These guidelines aim to improve the practices of fluid therapy by adopting a global perspective that considers both clinical efficacy and resource utilization in diverse healthcare settings. The guidelines address three key questions: (1) albumin versus crystalloids, (2) balanced crystalloids versus isotonic saline, and (3) small-volume hypertonic solutions versus isotonic crystalloids. Recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, ensuring a rigorous and transparent evaluation of the evidence across critical outcomes. Albumin was generally not favored over crystalloids due to its lack of demonstrated mortality benefit, higher cost, and limited availability in resource-limited settings. Balanced crystalloids were suggested over isotonic saline in most scenarios due to their potential to reduce mortality and mitigate the harmful effects of hyperchloremia, although the certainty of evidence was low. Small-volume hypertonic solutions were not shown to provide significant advantages over isotonic crystalloids, leading to a preference for the latter based on very low certainty evidence. This review provides an overview of the guideline development process and a detailed summary of their recommendations, highlighting key considerations for clinical practice. The guidelines also identify critical evidence gaps in fluid therapy research, underscoring the need for future studies to refine and optimize fluid management strategies in critically ill patients.
