CeraShield Endotracheal Tube Survey

Physician Data

Please provide your contact information. You can always opt out in the future.

Name & Surname(Required)

Country

Hospital Name(Required)

Position(Required)

Email(Required)

Cell Number(Required)

Would you like to receive 50 CeraShield ETTs to conduct a product evaluation study in your hospital?(Required)

Yes

Country Data

Please provide general data on country ICU infrastructure. If there is a significant change after Covid-19 please specify. If possible, cite local research papers & reports that are accepted locally to support the data.

Country

Number of ICU Beds

Number of Mechanical Ventilators

Estimated Annual Volume of ETTs

Standard of Care ETT ( e.g. subglottic suction)

VAP Incidence Rate, %

Avg. Cost of ICU Day, $

Hospital Information

Hospital Name

Hospital Website

Hospital Type & Specialization

Physician Name & Position

Physician Email

Hospital ICU Data

Please provide data on the basic ICU infrastructure for the selected site.

Number of Adult ICU Beds with Mechanical Ventilation

Average Occupancy %, Non Covid-19

Average Days on Mechanical Ventilation (MV)

MV Related Infection & Mortality

Please provide historical data on VAP, Mortality, Acute Kidney Injury, Delirium. Specify Covid-19, Pre-Covid-19 for the selected site.

VAP Incidence Rate

Calculate Number of Cases / Total Cases

Mortality Rate in MV Patients with VAP

Acute Kidney Failure in MV Patients Incidence Rate, %

Delirium in MV Patients Incidence Rate, %

Costs Associated with VAP

Please collect average historical data on costs associated with VAP or extras stay in ICU for the selected site.

Added Days (Average) due to VAP

Total Estimated Costs Per Patient, $

Sedation Costs as % of Total Estimated Costs

Antibiotics as % of Total Estimated Costs

Other Disposable Supplies as % of Total Estimated Costs