IFAD 2012

1. WRAP IT UP
2nd IFAD
Manu Malbrain
2nd IFAD – International Fluid Academy Day

2. Today’s Agenda
• Introduction
• What you should know about Fluids
• What you should know about Monitoring
• What you can learn about Antwerp
• What you can learn next year

3. WRAP IT UP
Introduction
2nd IFAD – International Fluid Academy Day

4. 250 Doctors
25 Faculty members
25 Industry representatives
X
300

5. 500 Delegates from 32 countries
• Physicians sessions
– 360
• Nursing Sessions
– 105
• Industry
– 35
• Total
– 500
Belgium
The Netherlands
United Kingdom
Germany
Spain
Ukraine
France
Lithuania
Israel
Italy
Nigeria
Argentina
Ireland
Albania
Brunei
Canada
Denmark
Egypt
Georgia
Ghana
Iran
Letland
Luxembourg
Malaysia
Oman
Pakistan
Poland
Serbia & Montenegro
Tsjechie
Turkey
USA

6. Beyond our Wildest Dreams…

7. WRAP IT UP
What you should
know about fluids
2nd IFAD – International Fluid Academy Day

9. MORNING
SESSIONS
Remember
SID!
Saline
Sucks!
Crystalloids
are not equal
Colloids are
not equal
SVR has a
place
Albumin has
a place
GIVE THE RIGHT FLUIDS RIGHT
PUSH THE BOUNDARIES
DONT FORGET MICROCIRCULATION

10. MORNING
SESSIONS
TBI
Hemorrhagic
shock
Sepsis
Heart Failure
Renal Failure
Liver Failure
USE THE RIGHT FLUID RIGHT
PUSH THE BOUNDARIES
DONT FORGET MICROCIRCULATION
ALI and ARDSIAH and ACS

11. WRAP IT UP
What you should know
about monitoring
2nd IFAD – International Fluid Academy Day

13. AFTERNOON
SESSIONS
Overload =
BAD
Goals =
dynamic
Each job has
a right tool
Closed Loops=
Mixed feelings
FR > Preload
Lactate =
Key/Clue
USE THE RIGHT MONITOR RIGHT
PUSH THE BOUNDARIES
DONT FORGET MICROCIRCULATION

14. AFTERNOON
SESSIONS
EIT and BIA
Cardiac
Output - BP
ICP and IAP
Microcircu-
lation
Peso and TDP
EVLWi
USE THE RIGHT MONITOR RIGHT
PUSH THE BOUNDARIES
DONT FORGET MICROCIRCULATION
Fluid
Responsiveness
ICG and dye
clearance
Minimal
Invasive
Non-
Invasive

15. WRAP IT UP
What you should
know about Antwerp
2nd IFAD – International Fluid Academy Day

16. Antwerp = Hand
throwing

25. 10 reasons to visit Antwerp Next year
1. Chocolate
2. Architecture
3. Diamonds
4. Fashion
5. Sea port
6. Rubens
7. Shopping
8. Nightlife
9. Fine Food, Beer
10. 3rd IFAD
What more do you need…?
3rd IFAD

26. WRAP IT UP
What you should
know about 3rd IFAD
2nd IFAD – International Fluid Academy Day

27. 3rd
MARK THE DATE!
FRIDAY AND SATURDAY NOV 29TH-30TH 2013 /
ANTWERP BELGIUM
A CONCISE BUT COMPLETE 2 DAY SYMPOSIUM ON FLUID MANAGEMENT AND MONITORING IN THE CRITICALLY ILL
INTERACTIVE VOTING SYSTEM / POSTER SESSIONS / WORKSHOPS / ACADEMY PRIZE AWARD /
NURSING SESSION / CASE DISCUSSIONS / STATE OF THE ART LECTURES / FLUID MANAGEMENT /
HEMODYNAMIC MONITORING / ORGAN SUPPORT AND MONITORING / ROUND TABLE DISCUSSIONS /
ANN.BOGAERTS@ZNA.BE WWW.FLUID-ACADEMY.ORG
FOLLOW US ON:ORGANIZED BY THE INTERNATIONAL FLUID ACADEMY
2 days

28. probably

30. iFAD - iPAD
again

31. Fluids :: Int J Med Fluid Management
Abstracts
Posters

33. There is
One More
Thing…
What you
should know
before going
home

34. We forgot to talk about:
Surviving Sepsis Guidelines…
• CVP: 8-12 mmHg
• Chasing a CVP may
lead to:
→ OVER resuscitation
→ UNDER resuscitation

36. Surviving Sepsis Guidelines

37. Crit Care Med 2008; [published correction appears in Crit Care Med 2008; 36:1394-1396] 36:296-327

38. Surviving Sepsis Guidelines

39. Thanks to our… Endorsing Societies

40. Thanks to… our Sponsors!

41. Thanks to… our Sponsors!
GOLD

42. Thanks to the Faculty

43. Thanks to… the people in the back
Thank You Ann

44. Evaluation
Take your Voting
Pad
2nd IFAD – International Fluid Academy Day
Saturday November 17th 2012

45. How did you find the overall
organisation of this meeting?
Please give your rating between 1 (very bad) to 10 (excellent)
0 100 200 300
10
9
8
7
6
5
4
3
2
1
Vo ng Distribu on
Thank You

46. There is
Another
One More
Thing…
What you
should know
before going
home

47. • Any measurement in the ICU stands or
falls with its accuracy and
reproducibility…
• No measurement has ever improved
survival, only a good a protocol can…
Protocolised Care?

48. Example of a Poor Protocol…
Trof RJ et al. CCM 2012; 40
EVLWI < 10
Fluid Challenge
GEDVI < 850
We must NOT give a fluid challenge

49. 788694
SURGICAL SEPTIC
GEDVI < 850 ml/m2 is too high

50. Ebb Phase of SHOCK
“Ashen faces, a
thready pulse and
cold clammy
extremities…”
The Ebb Phase - Cuthbertson,
Quart. J. Med.25:233,1932
Flow Phase of SHOCK
“The patient warms
up, cardiac output
increases and the
surgical team
relaxes…”
The Flow Phase - Cuthbertson.
Lancet 1:233, 1942
Fluid Guidance:
MAP, SVV, PPV,
GEF/GEDVI,
PLR, TEO
Fluid Guidance:
Positive (Σ) Fluid
balance, IAP,
EVLWI
EVLWI is NOT a trigger for Fluids

51. Moving Targets…
1st HIT
MAP, SVV,
PPV, ScvO2
2nd HIT
P/F, EVLWi,
IAP
3rd HIT
PVPI, ICG-
PDR
Moving Goals…
EAGD LGFR
LCFM
Give the right fluid right
Use the right monitor right

52. Although…
Sometimes it’s better
to have a lucky doctor
than a smart doctor !
But…

53. It’s always better
trying to do something
even if you don’t
succeed than doing
nothing and succeed
However…

54. Doing some kind of
monitoring will
preserve your
knowledge basis
Therefore…
RELAX
I only have 3 statements left…

55. WGAP Meeting at ESICM
ACS Workshop at ISICEM

56. CALL FOR ABSTRACTS!

57. 3rd
MARK THE DATE!
FRIDAY AND SATURDAY NOV 29TH-30TH 2013 /
ANTWERP BELGIUM
A CONCISE BUT COMPLETE 2 DAY SYMPOSIUM ON FLUID MANAGEMENT AND MONITORING IN THE CRITICALLY ILL
INTERACTIVE VOTING SYSTEM / POSTER SESSIONS / WORKSHOPS / ACADEMY PRIZE AWARD /
NURSING SESSION / CASE DISCUSSIONS / STATE OF THE ART LECTURES / FLUID MANAGEMENT /
HEMODYNAMIC MONITORING / ORGAN SUPPORT AND MONITORING / ROUND TABLE DISCUSSIONS /
ANN.BOGAERTS@ZNA.BE WWW.FLUID-ACADEMY.ORG
FOLLOW US ON:ORGANIZED BY THE INTERNATIONAL FLUID ACADEMY

58. THANK YOU
See You Next
Year!
2nd IFAD – International Fluid Academy Day
Saturday November 17th 2012