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To the Editor In a classic trial it would be necessary to randomize every patient before giving the first fluid dose, delaying the delivery of the therapy and increasing the workload of the staff. The unusual cluster randomized design with double crossover adopted in the SPLIT trial1 allowed enrollment of all patients needing fluid resuscitation in the 4 participating ICUs, with little disturbance of clinical practice.
Cavalcanti AB, Damiani LP, Bozza FA. Acute Kidney Injury With Buffered Crystalloids vs Saline Among ICU Patients. JAMA. 2016;315(14):1520. doi:10.1001/jama.2016.0154