Hi, I am Paul Elbers from The Netherlands and it's critically important to base fluid therapy on sound physiological principles, particularly those involving the right heart. You need to be careful when administering fluids and always consider the functional state of the right ventricle. If you give fluids when they're not indicated, you may worsen the patient's condition—the right heart can become distended, and this can impede left heart filling, ultimately leading to hemodynamic deterioration rather than improvement. In other words, what seems like a helpful intervention can backfire, especially if the right heart is already compromised. So clinical context and understanding of cardiac physiology are absolutely key. Another point worth noting is our use of diuretics—like furosemide (Lasix). If we indiscriminately remove just water, without accounting for solutes, we increase plasma tonicity. That shift can dehydrate cells, pulling water out of them and potentially causing harm, particularly in sensitive organs like the brain. This is why understanding fluid composition, volume status, and cellular hydration is so important—it's not just about the numbers on a fluid chart. What's great about this meeting is that everyone who truly understands fluids—or wants to—is here. As a speaker, it's a privilege to contribute, and it's exciting to engage with intensivists from all over the world who have come to learn, question, and share. It's a fascinating mix of people, and the atmosphere is both collegial and intellectually stimulating. Meetings like this don't just teach—they build a global community committed to better, smarter patient care.

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