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

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 *
University Affiliated *
Running Critical Care Medicine courses *
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 *


Type of ICU *
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 *
Flowtrac /PiCCO/ VolumeView available in ICU *
Trans-oesophageal echocardiography/Doppler machine available round the clock in ICU *
Is there an experienced/certified echocardiographer in the ICU team *
Is there a protocol for management of septic shock in your ICU? *