Clarington

This research evaluates magnesium supplementation protocols in critically ill patients, such as those with severe infections, heart attacks, or respiratory failure. The study aims to compare two different magnesium level targets to determine which leads to better outcomes in 30-day survival and reduced atrial fibrillation. This Phase 4 randomized controlled trial addresses an important uncertainty in routine intensive care unit (ICU) treatment by using an innovative electronic medical record (EMR)-embedded design across multiple hospitals in Ontario, Canada. Participants will be randomly assigned to one of two magnesium replacement protocols: a higher target level (greater than 0.95 mmol/L) or a lower target level (greater than 0.7 mmol/L). Magnesium sulfate is used for replacement in both groups, with additional oral options like magnesium oxide and magnesium glucoheptonate available in the higher-target group. The study is embedded within the EMR system, enabling seamless integration into standard ICU care without requiring extra tasks from participants. During the trial, participants will be monitored through their medical records without any additional tests or questionnaires. Researchers will measure outcomes including hospital mortality and days free of atrial fibrillation within 30 days after enrollment. Secondary measures include ventricular arrhythmias, use of vasopressors and ventilation, renal replacement therapy, lengths of ICU and hospital stay, and magnesium levels. The total participation aligns with the ICU stay and 30-day follow-up period, with data collected automatically through the EMR system.