Mauro Oddo1, Daniele Poole2, Raimund Helbok3, Geert Meyfroidt4, Nino Stocchetti5,6, Pierre Bouzat7, Maurizio Cecconi8, Thomas Geeraerts9, Ignacio Martin-Loeches10, Hervé Quintard11,12, Fabio Silvio Taccone13, Romergryko G Geocadin14, Claude Hemphill15, Carole Ichai16, David Menon17, Jean-François Payen7, Anders Perner18, Martin Smith19, José Suarez14, Walter Videtta20, Elisa R Zanier21, Giuseppe Citerio22,23. 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@chuv.ch. 2. Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy. 3. Neurological Intensive Care Unit, Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria. 4. Department of Intensive Care Medicine, University Hospitals Leuven, Louvain, Belgium. 5. Neuroscience Intensive Care Unit, Department of Anesthesia and Critical Care, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy. 6. Department of Pathophysiology and Transplants, University of Milan, Milan, Italy. 7. Department of Anesthesia and Critical Care, CHU Grenoble Alpes, 38000, Grenoble, France. 8. Department of Anaesthesia and Intensive Care, St. George's University Hospital, London, UK. 9. Department of Anaesthesia and Intensive Care, Toulouse University Hospital, University Toulouse 3-Paul Sabatier, 31059, Toulouse, France. 10. Department of Intensive Care Medicine, St James's University Hospital, James's St, Ushers, P.O. Box 580, Dublin 8, Ireland. 11. Service de Réanimation Médico-chirurgicale, Hôpital Pasteur 2, Université Côte d'Azur, CHU de Nice, 06000, Nice, France. 12. Unité CNRS 7275, Sophia-Antipolis, France. 13. Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium. 14. Neurosciences Critical Care, Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, Johns Hopkins University, Baltimore, MD, USA. 15. Department of Neurology, University of California San Francisco, San Francisco, CA, USA. 16. Service de Réanimation Polyvalente, Hôpital Pasteur 2, CHU de Nice, 30 Voie Romaine, CS 51069, 06001, Nice Cedex 1, France. 17. Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Box 93, Hills Road, Cambridge, Cambridgeshire, CB2 2QQ, UK. 18. Department of Intensive Care 4131, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark. 19. Department of Neuroanesthesia and Neurocritical Care, The National Hospital for Neurosurgery and Neurology, University College London Hospitals, London, UK. 20. Hospital Nacional Professor Alejandro Posadas, Buenos Aires, Argentina. 21. Department of Neurosciences, IRCCS-Istituto di Ricerche Farmacologiche Mario Negri, Milan, Italy. 22. School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. 23. Neurointensive Care, San Gerardo Hospital, ASST-Monza, 20900, Monza, Italy.
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.
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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