• 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, MøllerMorten HylanderMHDepartment of Intensive Care, Copenhagen University Hospital-Rigshospitalet, København, Denmark.Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark., Daniele Poole, Rob Mac Sweeney, Jean-Louis Vincent, Fernando G Zampieri, Fayez AlShamsi, and European Society of Intensive Care Medicine.
• Intensive Care Department, King Abdulaziz Medical City, Ministry of National Guard-Health Affairs, King Abdullah International Medical Research Center, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. arabi@mngha.med.sa.
• Intensive Care Med. 2024 Jun 1; 50 (6): 813831813-831.

PurposeThis 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.MethodsThis 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.ResultsFor 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).ConclusionsThis guideline provides eleven recommendations to inform clinicians on resuscitation fluid choice in critically ill patients.© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.

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