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31-03-2025 | Shock | Conference Reports and Expert Panel

European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids

Authors: Armand Mekontso Dessap, Fayez AlShamsi, Alessandro Belletti, Daniel De Backer, Anthony Delaney, Morten Hylander Møller, Segolène Gendreau, Glenn Hernandez, Flavia R. Machado, Mervyn Mer, Manuel Ignacio Monge Garcia, Sheila Nainan Myatra, Zhiyong Peng, Anders Perner, Michael R. Pinsky, Sameer Sharif, Jean-Louis Teboul, Antoine Vieillard-Baron, Waleed Alhazzani, the European Society of Intensive Care Medicine

Published in: Intensive Care Medicine | Issue 3/2025

Abstract

Objective

This European Society of Intensive Care Medicine (ESICM) guideline provides evidence-based recommendations on the volume of early resuscitation fluid for adult critically ill patients.

Methods

An international panel of experts developed the guideline, focusing on fluid resuscitation volume in adult critically ill patients with circulatory failure. Using the PICO format, questions were formulated, and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was applied to assess evidence and formulate recommendations.

Results

In adults with sepsis or septic shock, the guideline suggests administering up to 30 ml/kg of intravenous crystalloids in the initial phase, with adjustments based on clinical context and frequent reassessments (very low certainty of evidence). We suggest using an individualized approach in the optimization phase (very low certainty of evidence). No recommendation could be made for or against restrictive or liberal fluid strategies in the optimization phase (moderate certainty of no effect). For hemorrhagic shock, a restrictive fluid strategy is suggested after blunt trauma (moderate certainty) and penetrating trauma (low certainty), with fluid administration for non-traumatic hemorrhagic shock guided by hemodynamic and biochemical parameters (ungraded best practice). For circulatory failure due to left-sided cardiogenic shock, fluid resuscitation as the primary treatment is not recommended. Fluids should be administered cautiously for cardiac tamponade until definitive treatment and guided by surrogate markers of right heart congestion in acute pulmonary embolism (ungraded best practice). No recommendation could be made for circulatory failure associated with acute respiratory distress syndrome.

Conclusions

The panel made four conditional recommendations and four ungraded best practice statements. No recommendations were made for two questions. Knowledge gaps were identified, and suggestions for future research were provided.

Available only for authorised users

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Title: European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids
Authors: Armand Mekontso Dessap
Fayez AlShamsi
Alessandro Belletti
Daniel De Backer
Anthony Delaney
Morten Hylander Møller
Segolène Gendreau
Glenn Hernandez
Flavia R. Machado
Mervyn Mer
Manuel Ignacio Monge Garcia
Sheila Nainan Myatra
Zhiyong Peng
Anders Perner
Michael R. Pinsky
Sameer Sharif
Jean-Louis Teboul
Antoine Vieillard-Baron
Waleed Alhazzani
the European Society of Intensive Care Medicine
Publication date: 31-03-2025
Publisher: Springer Berlin Heidelberg
Keywords: Shock
Shock
Acute Respiratory Distress Syndrome
Acute Respiratory Distress Syndrome
Cardiogenic Shock
Cardiogenic Shock
Septic Shock
Septicemia
Septicemia
Published in: Intensive Care Medicine / Issue 3/2025
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-025-07840-1

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European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2—the volume of resuscitation fluids

Abstract

Objective

Methods

Results

Conclusions

Other articles of this Issue 3/2025

Correction: Association of hospital and intensive care unit occupancy and non-admission to the intensive care unit decisions: a retrospective cohort study

How AI can help in error detection and prevention in the ICU?

The value of pilot trials in studies of postoperative sedation in critical care

Modernizing autopsy practices in the ICU to advance critical care diagnostics

Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation. Authors’ reply

Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database

Navigating neuroimaging in Alzheimer disease care

Springer Medicine

Abstract

Objective

Methods

Results

Conclusions

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Correction: Association of hospital and intensive care unit occupancy and non-admission to the intensive care unit decisions: a retrospective cohort study

How AI can help in error detection and prevention in the ICU?

The value of pilot trials in studies of postoperative sedation in critical care

Modernizing autopsy practices in the ICU to advance critical care diagnostics

Conservative or liberal oxygen targets in patients on venoarterial extracorporeal membrane oxygenation. Authors’ reply

Shortening antibiotic therapy duration for hospital-acquired bloodstream infections in critically ill patients: a causal inference model from the international EUROBACT-2 database