If the hospital has more than one ICU, each ICU should register separately

Name of the hospital *

City *

INVESTIGATOR INFORMATION

(Up to two investigators can be registered per ICU)

Name of the Principal Investigator

First *

Middle

Last *

Email *

Cell No *

Name of the Co- Investigator

First

Middle

Last

Email

Cell No

HOSPITAL DEMOGRAPHICS

Type of hospital * PublicPrivate

University Affiliated * YesNo

Running Critical Care Medicine courses * YesNo

If yes * DM FNB/DNB IDCCM IFCCM PDCC Other

Total number of beds in the hospital *

Total number of ICUs in the hospital *

Total number of ICU beds in your hospital *

Total number of ICU admissions per year in your hospital *

PARTICIPATING ICU DEMOGRAPHICS

Type of ICU * OpenedClosedSemi Closed

Number of beds *

Number of admission per year *

Number of ventilators *

Average number of patients per nurse *

Average number of patients per doctor *

Bedside trans-thoracic echocardiography machine available round the clock in ICU * YesNo

Flowtrac /PiCCO/ VolumeView available in ICU * YesNo

Trans-oesophageal echocardiography/Doppler machine available round the clock in ICU * YesNo

Is there an experienced/certified echocardiographer in the ICU team * YesNo

Is there a protocol for management of septic shock in your ICU? * YesNo

Thank You

HERMES Study ICU Registration is closed now.

ICU Registration Form
Hemodynamic Resuscitation and Monitoring in Early Sepsis (HERMES Study)

INVESTIGATOR INFORMATION

Name of the Principal Investigator

Name of the Co- Investigator

HOSPITAL DEMOGRAPHICS

PARTICIPATING ICU DEMOGRAPHICS

Thank You

HERMES Study ICU Registration is closed now.

ICU Registration Form Hemodynamic Resuscitation and Monitoring in Early Sepsis (HERMES Study)

INVESTIGATOR INFORMATION

Name of the Principal Investigator

Name of the Co- Investigator

HOSPITAL DEMOGRAPHICS

PARTICIPATING ICU DEMOGRAPHICS

ICU Registration Form
Hemodynamic Resuscitation and Monitoring in Early Sepsis (HERMES Study)