Hemodynamics, fluids & transfusion
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
Methodological detailsGRADE approach, PICO format, international expert panel
- GRADE approach
- PICO format
- International expert panel
Recommendations
As issued by the authors
- very low certainty of evidence
Sepsis or septic shock: suggest up to 30 ml/kg IV crystalloids in the initial phase, adjusted to clinical context with frequent reassessments
- very low certainty of evidence
Sepsis: suggest an individualized approach in the optimization phase
- moderate certainty of no effect
No recommendation for or against restrictive or liberal fluid strategies in the optimization phase
- moderate certainty
Hemorrhagic shock after blunt trauma: restrictive fluid strategy suggested
- low certainty
Hemorrhagic shock after penetrating trauma: restrictive fluid strategy suggested
- ungraded best practice
Non-traumatic hemorrhagic shock: fluid administration guided by hemodynamic and biochemical parameters
Left-sided cardiogenic shock: fluid resuscitation as primary treatment not recommended
- ungraded best practice
Cardiac tamponade: fluids cautiously until definitive treatment; acute PE: fluids guided by surrogate markers of right heart congestion
No recommendation for circulatory failure associated with ARDS
Original publication
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