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

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Abstract

Objective

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

Design

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.

Methods

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.

Results

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

Conclusions

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

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Funding

No external funding was obtained for this research.

Author information

Author notes

  1. Mauro Oddo and Daniele Poole contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Medical-Surgical Intensive Care Medicine, Faculty of Biology and Medicine, Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Rue du Bugnon 46, BH 08.623, 1011, Lausanne, Switzerland

    Mauro Oddo

  2. Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy

    Daniele Poole

  3. Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria

    Raimund Helbok

  4. Department of Intensive Care Medicine, University Hospitals Leuven, Louvain, Belgium

    Geert Meyfroidt

  5. Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico, Milan, Italy

    Nino Stocchetti

  6. Department of Pathophysiology and Transplants, University of Milan, Milan, Italy

    Nino Stocchetti

  7. Department of Anesthesia and Critical Care, CHU Grenoble Alpes, 38000, Grenoble, France

    Pierre Bouzat & Jean-François Payen

  8. Department of Anaesthesia and Intensive Care, St. George’s University Hospital, London, UK

    Maurizio Cecconi

  9. Department of Anaesthesia and Intensive Care, Toulouse University Hospital, University Toulouse 3-Paul Sabatier, 31059, Toulouse, France

    Thomas Geeraerts

  10. Department of Intensive Care Medicine, St James’s University Hospital, James’s St, Ushers, P.O. Box 580, Dublin 8, Ireland

    Ignacio Martin-Loeches

  11. Service de Réanimation Médico-chirurgicale, Hôpital Pasteur 2, Université Côte d’Azur, CHU de Nice, 06000, Nice, France

    Hervé Quintard

  12. Unité CNRS 7275, Sophia-Antipolis, France

    Hervé Quintard

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

    Fabio Silvio Taccone

  14. Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA

    Romergryko G. Geocadin & José Suarez

  15. Department of Neurology, University of California San Francisco, San Francisco, CA, USA

    Claude Hemphill

  16. Service de Réanimation Polyvalente, Hôpital Pasteur 2, CHU de Nice, 30 Voie Romaine, CS 51069, 06001, Nice Cedex 1, France

    Carole Ichai

  17. Division of Anaesthesia, University of Cambridge, Addenbrooke’s Hospital, Box 93, Hills Road, Cambridge, Cambridgeshire, CB2 2QQ, UK

    David Menon

  18. Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark

    Anders Perner

  19. Department of Neuroanesthesia and Neurocritical Care, The National Hospital for Neurosurgery and Neurology, University College London Hospitals, London, UK

    Martin Smith

  20. Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina

    Walter Videtta

  21. Department of Neurosciences, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy

    Elisa R. Zanier

  22. School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy

    Giuseppe Citerio

  23. Neurointensive Care, San Gerardo Hospital, ASST-Monza, 20900, Monza, Italy

    Giuseppe Citerio

Authors
  1. Mauro Oddo
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  2. Daniele Poole
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  3. Raimund Helbok
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  4. Geert Meyfroidt
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  5. Nino Stocchetti
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  6. Pierre Bouzat
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  7. Maurizio Cecconi
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  8. Thomas Geeraerts
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  9. Ignacio Martin-Loeches
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  10. Hervé Quintard
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  11. Fabio Silvio Taccone
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  12. Romergryko G. Geocadin
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  13. Claude Hemphill
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  14. Carole Ichai
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  15. David Menon
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  16. Jean-François Payen
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  17. Anders Perner
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  18. Martin Smith
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  19. José Suarez
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  20. Walter Videtta
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  21. Elisa R. Zanier
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  22. Giuseppe Citerio
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Corresponding author

Correspondence to Mauro Oddo.

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The authors declare no conflict of interest for this manuscript.

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Oddo, M., Poole, D., Helbok, R. et al. Fluid therapy in neurointensive care patients: ESICM consensus and clinical practice recommendations. Intensive Care Med 44, 449–463 (2018). https://doi.org/10.1007/s00134-018-5086-z

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  • DOI: https://doi.org/10.1007/s00134-018-5086-z

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