Isotonic Solution Administration Logistical Testing

The administration of intravenous crystalloids is ubiquitous in the care of the critically
ill. Commonly available crystalloid solutions contain a broad spectrum of electrolyte
compositions including a range of chloride concentrations. Recent studies of associated
higher fluid chloride content with acute kidney injury and mortality but no large,
randomized trials have been conducted. In preparation for a large, cluster-randomized,
multiple-crossover trial comparing 0.9% sodium chloride to physiologically-balanced isotonic
crystalloids (Lactated Ringers or Plasmalyte-A) in intensive care unit patients, this pilot
study will enroll all patients admitted to the medical intensive care unit at a single
tertiary center for a sixth month period. The primary objective will be to test the ability
of an electronic order entry tool to ensure administration of assigned study fluid or record
contraindications to assigned study fluid. The pilot study will also demonstrate the
feasibility of collecting demographic, severity of illness, fluid management, vital sign,
laboratory, acute kidney injury and renal replacement therapy, and outcome data in an
automated, electronic fashion.