At the investigators institution, there are two critical care units that serve the majority of surgical, traumatic, and neurovascular critically ill patients (The surgical trauma unit and neurologic intensive care unit). These two units work in tandem and their patient populations are distributed throughout both units (hereafter referred to as the ICU). Patients requiring mechanical ventilation will be randomized into a control arm or trial arm of the study. The following demographic data will be collected: patient age, gender, race, indication for mechanical ventilation, APACHE II score, injury severity score (if patient is a trauma patient), and serum creatinine. All data will be recorded without patient identifiers to maintain confidentiality. Specific methods are detailed below.