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Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force

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Abstract

An international team of experts in the field of fluid resuscitation was invited by the ESICM to form a task force to systematically review the evidence concerning fluid administration using basic monitoring. The work included a particular emphasis on pre-ICU hospital settings and resource-limited settings. The work focused on four main questions: (1) What is the role of clinical assessment to guide fluid resuscitation in shock? (2) What basic monitoring is required to perform and interpret a fluid challenge? (3) What defines a fluid challenge in terms of fluid type, ranges of volume, and rate of administration? (4) What are the safety endpoints during a fluid challenge? The expert panel found insufficient evidence to provide recommendations according to the GRADE system, and was only able to make recommendations for basic interventions, based on the available evidence and expert opinion. The panel identified significant gaps in the scientific evidence on fluid administration outside the ICU (excluding the operating theater). Globally, scientific communities and health care systems should address these critical gaps in evidence through research on how basic fluid administration in resource-rich and resource-limited settings can be improved for the benefit of patients and societies worldwide.

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Acknowledgements

One of the authors (JG) passed away before completion of the final draft. The group felt that his immense contribution was instrumental in the initiation and completion of this project. For this reason, there was a unanimous decision to include JG as co-author despite the fact that he was not able to see the final draft.

Author information

Authors and Affiliations

  1. Humanitas Clinical and Research Center, Milan, Italy

    Maurizio Cecconi

  2. Department of Biomedical Sciences, Humanitas University, Milan, Italy

    Maurizio Cecconi

  3. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile

    Glenn Hernandez & Jan Bakker

  4. Department of Anesthesiology and Intensive Care Medicine, Kepler University Hospital, Johannes Kepler University, Linz, Austria

    Martin Dunser

  5. Department of Anesthesiology and Intensive Care, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario ‘A. Gemelli’ IRCCS, Largo Agostino Gemelli, 8, 00168, Rome, Italy

    Massimo Antonelli

  6. College of Medicine, Blantyre, Malawi

    Tim Baker

  7. Perioperative medicine and intensive care (PMI), Karolinska University Hospital, Stockholm, Sweden

    Tim Baker

  8. Department of Pulmonology and Critical Care, Langone Medical Center-Bellevue Hospital, New York University, New York, NY, USA

    Jan Bakker

  9. Department of Intensive Care Adults, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands

    Jan Bakker

  10. Division of Pulmonary, Allergy and Critical Care, University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA

    Jan Bakker

  11. Department of Pulmonary and Critical Care, New York University, 462 First avenue, New York, NY, 10016, USA

    Jan Bakker

  12. Laboratoire d’Etude de la Microcirculation, UMR 942, Université Paris 7, Hôpitaux Saint Louis Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France

    Jacques Duranteau

  13. Service d’Anesthésie-Réanimation Chirurgicale, UMR 942, Hôpital de Bicêtre, Université Paris-Sud, Hôpitaux Universitaires Paris-Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France

    Jacques Duranteau

  14. Department of Anesthesia , Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel

    Sharon Einav

  15. Institute for Cardiovascular Research ICaR-VU, VU University Medical Center, Amsterdam, The Netherlands

    A. B. Johan Groeneveld

  16. Emergency Department, Royal London Hospita, Barts Health NHS Trust, London, UK

    Tim Harris

  17. Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK

    Tim Harris

  18. Deenanath Mangeshkar Hospital and Research center, Pune, India

    Sameer Jog

  19. Anesthesiology, Pain, and Intensive Care Department, Universidade Federal de São Paulo, São Paulo, Brazil

    Flavia R. Machado

  20. Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Mervyn Mer

  21. Unidad de Cuidados Intensivos, Hospital SAS de Jerez, Jerez de La Frontera, Spain

    M. Ignacio Monge García

  22. Department of Anesthesiology, Critical Care and Pain, Tata Memorial Hospital, Mumbai, India

    Sheila Nainan Myatra

  23. Department of Intensive Care, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark

    Anders Perner

  24. Hôpitaux universitaires Paris-Sud, Hôpital de Bicêtre, service de réanimation médicale, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Jean-Louis Teboul

  25. Inserm UMR S_999, Univ Paris-Sud, 78, rue du Général Leclerc, 94270, Le Kremlin-Bicêtre, France

    Jean-Louis Teboul

  26. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Jean-Louis Vincent

  27. Department of Intensive Care, CHIREC Hospitals, Université Libre de Bruxelles, 35 Rue Wayez, 1420, Braine L’Alleud, Belgium

    Daniel De Backer

Authors
  1. Maurizio Cecconi
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  2. Glenn Hernandez
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  3. Martin Dunser
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  4. Massimo Antonelli
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  5. Tim Baker
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  6. Jan Bakker
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  7. Jacques Duranteau
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  8. Sharon Einav
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  9. A. B. Johan Groeneveld
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  10. Tim Harris
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  11. Sameer Jog
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  12. Flavia R. Machado
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  13. Mervyn Mer
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  14. M. Ignacio Monge García
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  15. Sheila Nainan Myatra
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  16. Anders Perner
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  17. Jean-Louis Teboul
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  18. Jean-Louis Vincent
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  19. Daniel De Backer
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Corresponding author

Correspondence to Maurizio Cecconi.

Additional information

​The ​original ​version ​of ​this ​article ​was ​revised: The spelling of Jacques Duranteau’s name was incorrect.

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Cecconi, M., Hernandez, G., Dunser, M. et al. Fluid administration for acute circulatory dysfunction using basic monitoring: narrative review and expert panel recommendations from an ESICM task force. Intensive Care Med 45, 21–32 (2019). https://doi.org/10.1007/s00134-018-5415-2

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  • DOI: https://doi.org/10.1007/s00134-018-5415-2

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