Intensive Care Medicine

, Volume 44, Issue 4, pp 449–463 | Cite as

Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations

  • Mauro OddoEmail author
  • Daniele Poole
  • Raimund Helbok
  • Geert Meyfroidt
  • Nino Stocchetti
  • Pierre Bouzat
  • Maurizio Cecconi
  • Thomas Geeraerts
  • Ignacio Martin-Loeches
  • Hervé Quintard
  • Fabio Silvio Taccone
  • Romergryko G. Geocadin
  • Claude Hemphill
  • Carole Ichai
  • David Menon
  • Jean-François Payen
  • Anders Perner
  • Martin Smith
  • José Suarez
  • Walter Videtta
  • Elisa R. Zanier
  • Giuseppe Citerio
Conference Reports and Expert Panel



To report the ESICM consensus and clinical practice recommendations on fluid therapy in neurointensive care patients.


A consensus committee comprising 22 international experts met in October 2016 during ESICM LIVES2016. Teleconferences and electronic-based discussions between the members of the committee subsequently served to discuss and develop the consensus process.


Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles generated. The consensus focused on three main topics: (1) general fluid resuscitation and maintenance in neurointensive care patients, (2) hyperosmolar fluids for intracranial pressure control, (3) fluid management in delayed cerebral ischemia after subarachnoid haemorrhage. After an extensive literature search, the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system were applied to assess the quality of evidence (from high to very low), to formulate treatment recommendations as strong or weak, and to issue best practice statements when applicable. A modified Delphi process based on the integration of evidence provided by the literature and expert opinions—using a sequential approach to avoid biases and misinterpretations—was used to generate the final consensus statement.


The final consensus comprises a total of 32 statements, including 13 strong recommendations and 17 weak recommendations. No recommendations were provided for two statements.


We present a consensus statement and clinical practice recommendations on fluid therapy for neurointensive care patients.


Evidence‐based medicine Guidelines Fluid therapy Traumatic brain injury Subarachnoid haemorrhage Intracerebral haemorrhage Stroke Mannitol Hypertonic Neurointensive care 



No external funding was obtained for this research.

Compliance with ethical standards

Conflicts of interest

The authors declare no conflict of interest for this manuscript.

Supplementary material

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Mauro Oddo
    • 1
    Email author
  • Daniele Poole
    • 2
  • Raimund Helbok
    • 3
  • Geert Meyfroidt
    • 4
  • Nino Stocchetti
    • 5
    • 6
  • Pierre Bouzat
    • 7
  • Maurizio Cecconi
    • 8
  • Thomas Geeraerts
    • 9
  • Ignacio Martin-Loeches
    • 10
  • Hervé Quintard
    • 11
    • 12
  • Fabio Silvio Taccone
    • 13
  • Romergryko G. Geocadin
    • 14
  • Claude Hemphill
    • 15
  • Carole Ichai
    • 16
  • David Menon
    • 17
  • Jean-François Payen
    • 7
  • Anders Perner
    • 18
  • Martin Smith
    • 19
  • José Suarez
    • 14
  • Walter Videtta
    • 20
  • Elisa R. Zanier
    • 21
  • Giuseppe Citerio
    • 22
    • 23
  1. 1.Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire Vaudois (CHUV)University of LausanneLausanneSwitzerland
  2. 2.Anesthesia and Intensive Care Operative UnitS. Martino HospitalBellunoItaly
  3. 3.Neurological Intensive Care Unit, Department of NeurologyMedical University of InnsbruckInnsbruckAustria
  4. 4.Department of Intensive Care MedicineUniversity Hospitals LeuvenLouvainBelgium
  5. 5.Neuroscience Intensive Care Unit, Department of Anesthesia and Critical CareFondazione IRCCS Ca’ Granda-Ospedale Maggiore PoliclinicoMilanItaly
  6. 6.Department of Pathophysiology and TransplantsUniversity of MilanMilanItaly
  7. 7.Department of Anesthesia and Critical CareCHU Grenoble AlpesGrenobleFrance
  8. 8.Department of Anaesthesia and Intensive CareSt. George’s University HospitalLondonUK
  9. 9.Department of Anaesthesia and Intensive Care, Toulouse University HospitalUniversity Toulouse 3-Paul SabatierToulouseFrance
  10. 10.Department of Intensive Care MedicineSt James’s University HospitalDublin 8Ireland
  11. 11.Service de Réanimation Médico-chirurgicale, Hôpital Pasteur 2Université Côte d’AzurNiceFrance
  12. 12.Unité CNRS 7275Sophia-AntipolisFrance
  13. 13.Department of Intensive Care, Erasme HospitalUniversité Libre de BruxellesBrusselsBelgium
  14. 14.Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and NeurosurgeryJohns Hopkins UniversityBaltimoreUSA
  15. 15.Department of NeurologyUniversity of California San FranciscoSan FranciscoUSA
  16. 16.Service de Réanimation PolyvalenteHôpital Pasteur 2, CHU de NiceNice Cedex 1France
  17. 17.Division of AnaesthesiaUniversity of Cambridge, Addenbrooke’s HospitalCambridgeUK
  18. 18.Department of Intensive Care 4131Copenhagen University Hospital-RigshospitaletCopenhagenDenmark
  19. 19.Department of Neuroanesthesia and Neurocritical Care, The National Hospital for Neurosurgery and NeurologyUniversity College London HospitalsLondonUK
  20. 20.Hospital Nacional Professor Alejandro PosadasBuenos AiresArgentina
  21. 21.Department of NeurosciencesIRCCS-Istituto di Ricerche Farmacologiche Mario NegriMilanItaly
  22. 22.School of Medicine and SurgeryUniversity of Milan-BicoccaMilanItaly
  23. 23.Neurointensive CareSan Gerardo Hospital, ASST-MonzaMonzaItaly

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