Why are we still giving fluids to test fluid responsiveness? Today, we have methods to predict fluid responsiveness without administering a single drop of fluid. I'm referring, of course, to the passive leg raising (PLR) test, which functions as a reversible fluid challenge. I am Xavier Monnet from Paris in France and in my lecture today, I focused on the concept of fluid challenges—or more precisely, preload challenges. What we really need is not a fluid challenge that risks overloading the patient, but rather a safe and reversible preload test to determine whether the patient is preload responsive. That's why I advocate for using passive leg raising. It's a dynamic and physiological way to test the patient's position on the Frank-Starling curve—at the bedside, in real time. If cardiac output increases during PLR, you can reasonably assume that it would also increase after giving a real fluid bolus—without actually needing to give one. This helps avoid unnecessary fluid administration and the risks that come with it. It's important to recognize that fluid challenges inherently risk fluid overload, especially if repeated. This is why we should shift toward preload challenges without fluids, using PLR as a safer and more effective alternative. I've been attending this congress since its very first edition, and I can honestly say it's a wonderful event. What makes it unique is its dedication to fluids, not just from a clinical angle but starting with foundational physiology and extending all the way to practical bedside tools like cardiac ultrasound. The faculty list is outstanding, and what really stands out is the quality of the attendees—these are people with a genuine interest in hemodynamics, people with a strong hemodynamic culture. Conversations here are always stimulating, meaningful, and clinically relevant. This congress truly ranks among the most interesting and high-value meetings in critical care across Europe.

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