Fluid therapy is still the mainstay of acute care in patients with shock or cardiovascular compromise. However, our understanding of the critically ill pathophysiology has evolved significantly in recent years. The revelation of the glycocalyx layer and subsequent research has redefined the basics of fluids behavior in the circulation. Using less invasive hemodynamic monitoring tools enables us to assess the cardiovascular function in a dynamic perspective. This allows pinpointing even distinct changes induced by treatment, by postural changes, or by interorgan interactions in real time and enables individualized patient management. Regarding fluids as drugs of any other kind led to the need for precise indication, way of administration, and also assessment of side effects. We possess now the evidence that patient centered outcomes may be altered when incorrect time, dose, or type of fluids are administered. In this review, three major features of fluid therapy are discussed: the prediction of fluid responsiveness, potential harms induced by overzealous fluid administration, and finally the problem of protocol-led treatments and their timing.

Department of Anaesthesiology and Intensive Therapy Faculty of Medicine University of Szeged 6 Semmelweis Street Szeged 6725 Hungary

Department of Anesthesia and Intensive Care Medicine University Teaching Hospital and Faculty of Medicine in Plzen Charles University Prague Alej Svobody 80 32300 Plzen Czech Republic

Department of Anesthesiology and Intensive Care Medicine Northern State Medical University Arkhangelsk 163000 Russia

Department of Cardiology and Department of Research and Education General Hospital Celje Oblakova 5 SI 3000 Celje Slovenia

Faculty of Medicine University of Ljubljana Vrazov trg 2 SI 1000 Ljubljana Slovenia

Medical ICU General Hospital Celje Oblakova 5 SI 3000 Celje Slovenia

Medical ICU Paris Sud University Hospitals Inserm UMR S 999 Paris Sud University 94 270 Le Kremlin Bicêtre France

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