Rational Use of Intravenous Fluids in Critically Ill Patients

This open access book, published by Springer under the Open Access CC BY 4.0 Licence in collaboration with the International Fluid Academy (IFA, www.fluidacademy.org), explores rationalized intravenous fluid therapy for critically ill patients. Despite being commonly prescribed in inpatient settings, intravenous fluids are often administered without evidence-based guidelines, neglecting essential considerations such as the fact they are drugs, that need proper dosing, duration, indications, contraindications, side effects, and de-escalation. This book fills this knowledge gap.

Each chapter starts with a clinical vignette and a related question, followed by a concise summary abstract, key learning points, main text, and a conclusion that addresses the clinical question and provides relevant take-home messages. Additionally, every chapter includes an IFA commentary referencing the latest literature and evidence. The book begins with an introductory chapter that provides definitions and terminology, followed by four sections.

The first section covers the fundamentals of intravenous fluid therapy, including fluid compartments in sick patients, fluid bolus dynamics, heart-lung interactions, fluid challenge, fluid responsiveness, arterial blood gas analysis based on traditional and Stewart concepts, and electrolyte physiology relevant to clinical issues. The second section discusses commercially available intravenous fluids, while the third section focuses on fluid therapy in specific clinical situations. The final section introduces the concepts of fluid stewardship and appropriate fluid prescription.

Aligned with the International Fluid Academy's mission to enhance education and promote research on fluid management and monitoring, ultimately improving patient survival rates, this book contributes significantly to establishing fluid stewardship at the bedside. It provides valuable support for physicians, nurses, pharmacists, and other healthcare professionals across various clinical disciplines working in emergency rooms, operating rooms, or intensive care units, aiding their everyday clinical practice.

Manu L.N.G. Malbrain is professor of Critical Care Research at the First Department of Anaesthesiology and Intensive Therapy at the Medical University of Lublin in Poland and Chief Medical Officer (CMO) of Medaman (on medical data management) in Geel, Belgium. Prof. Malbrain is the president and one of the the co-founders of the International Fluid Academy (IFA, www.fluidacademy.org). The IFA is now fully integrated within the not-for-profit organisation iMERiT vzw (International medical education and research initiative) under Belgian law. The IFA recently became an official specialist organisation of the European Society of Anaesthesiology and Intensive Care (ESAIC) where he is member of the Scientific Subcommittee. He is actively involved in the European Society of Intensive Care Medicine (ESICM) where he chaired the Working group on abdominal problems (WGAP) within the POIC section (2009-2013). He studied the effects of raised intra-abdominal pressure in general ICU patients for the last 30 years. He is co-founder, past-president and actual treasurer of the Abdominal Compartment Society (formerly known as World Society on Abdominal Compartment Syndrome, WSACS, www.wsacs.org) and he co-chaired the previous 12 annual international fluid academy day (IFAD) and 8 bi-annual world congress abdominal compartment society (WCACS) meetings since 2004. Besides IAP and fluid management, his favourite topic is less invasive (hemodynamic) monitoring and he enjoys his active involvement in (bedside) teaching and education of medical trainees and students. In 2003 he was the first ESICM Chris Stoutenbeek Award winner in Amsterdam with a study protocol on different intra-abdominal pressure measurement methods and he successfully defended his PhD doctorate's thesis in 2007 on the same topic (KU Leuven, Belgium). He gave more than 1000 lectures at (inter)national scientific meetings, is author and co-author of more than 330 peer-reviewed articles, reviews, editorials, bookchapters and a couple of books on abdominal hypertension, compartment syndromes and point-of-care ultrasound.

Dr. Adrian Wong completed his training in anaesthesia & intensive care in 2014 and is a Consultant and Clinical Lead at King's College Hospital, London. Within critical care, he has an interest in the use of point-of-care ultrasound to guide fluid management, especially around venous congestion and organ perfusion, and human factors in the time critical environment of the ICU. His other research interest includes clinical governance and safety, medical education and burnout/well-being.

He is a member of the Intensive Care Society FUSIC Committee, is an examiner for the European Diploma of Intensive Care Medicine. He was the ex-chair of the Social Media and Digital Content Committee of the ESICM and the Course Director of the GENIUS Ultrasound course. He is on the executive committee of the International Fluid Academy.

Dr. Nasa has over 25years of experience in healthcare and has been working as a team lead in Critical Care Medicine for over 12 years in tertiary-level acute hospitals in New Delhi and Dubai. Besides being a full-time intensivist with a core interest in infection control, he is responsible for risk management and strategic decision-making regarding patient and staff safety.

Dr. Nasa is an avid clinical researcher with areas of interest including fluid stewardship, sepsis, and mechanical ventilation. He has authored over 65 publications indexed on PubMed, with more than 1250 citations.

From 2022 to 2023, Dr. Nasa served as an Associate Editor for Critical Care Communications, the official newsletter of the Indian Society of Critical Care Medicine. Since 2019, he has been collaborating with Professor Malbrain to promote the philosophy of the International Fluid Academy. Currently, Dr. Nasa is pursuing a PhD in Intensive Care at Amsterdam University Medical Centers in the Netherlands. He actively contributes as a member of the Hospital Central Scientific Committee and the Regional Research and Ethics Committee. Dr. Nasa holds an adjunct faculty position at the College of Medicine and Health Sciences, United Arab Emirates, reflecting his strong interest in academia.

Dr Ghosh is the Director and Head of the Department of Critical Care Medicine at Fortis Escorts Hospital, Faridabad, India. He is a passionate teacher and is involved in training of critical care fellows for past over fifteen years. His areas of expertise include resuscitation including intravenous fluid therapy, noninvasive respiratory support of critically ill patients, antimicrobial stewardship and quality improvement in intensive care. Dr Ghosh is the founder of the "Fluid Academy of India" - a nonprofit organization involved in training and research on fluid stewardship in India. Dr Supradip Ghosh is the author of the well known book on fluid therapy "Handbook of Intravenous Fluids" published by Springer-Singapore in 2022