Intravenous fluids for vascular loading

Purpose > To provide recommendations for the appropriate choice of fluid therapy for resuscita-tion of critically ill patients.Design > A consensus committee of 24 experts from the French societies of anesthesiology and critical care medicine (Societe Francaise d'Anesthesie-Reanimation, SFAR) and emergency medi-cine (Societe Francaise de Medecine d'Urgence, SFMU) was convened. A formal conflict-of -interest policy was developed at the onset of the process and enforced throughout. The entire guidelines process was conducted independently of any industry funding. The authors were advised to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide assessment of quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. Some recommendations were ungraded.Methods > Four fields were defined: patients with sepsis or septic shock, patients with haemor-rhagic shock, patients with acute brain failure, and patients during the peripartum period. For each field, the panel focused on two questions for diagnostic strategy: 1) Does the use of colloids, as compared to crystalloids, reduce morbidity and mortality, and 2) Does the use of some specific crystalloids reduce morbidity and mortality. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. The analysis of the literature and the recommendations were then conducted according to the GRADE methodology.Results > The SFAR/SFMU guideline panel provided nine statements on the appropriate choice of fluid therapy for resuscitation of critically ill patients. After two rounds of discussion and various amendments, a strong agreement was reached for 100% of recommendations. Of these recommendations, two have a high level of evidence (Grade 1 +-), six have a low level of evidence (Grade 2 +-), and one is based on expert judgement. Finally, no recommendation was formulated for two questions.Conclusions > Substantial agreement exists among experts for many strong recommendations aiming at optimizing the choice of fluid therapy for resuscitation of critically ill patients. Recommandations Formalisees