Data Collection Tool Standard Study Questions: Admission Date: Admission Time: Age: Gender: Specifics of Injury: Time of Injury: Mechanism of Injury Blunt vs Penetrating? Injury Severity Score? Injuries: Chest Abbreviated Injury Score: Initial GCS: Intubation: Time of Intubation: Location of Intubation: Initial Ventilator Settings Prior to Initiation of Protocol: Date/Time of Initiation of Protocol: Volume: Volume of crystalloid infused prior to Initiation of Protocol: Blood products Infused Prior to Initiation of Protocol: PRBC Volume: FFP Volume: Platelet Volume: Total crystalloid infused while intubated: Total blood products infused while intubated PRBC volume: FFP volume: Platelet Volume: Admission Values Hemoglobin: ABG: Lactate: Base Deficit: BUN: Creatinine: Vitals: PF Ratio:
Hospital Course: Ventilator Settings and Changes: Date/Time Pulse Ox EtCO2 ABG Ventilator Settings (per protocol) Vasopressor and Inotrope Usage: Date/Time Vasopressor/Inotrope Dose Renal Function Date/Time BUN/Cr UOP<0.5ml/kg/hr for >6 hours in previous 24 hours Complications Hospital Acquired Pneumonia? Ventilator Associated Pneumonia? Blood Stream Infection? Catheter Associated Urinary Tract Infection? Sepsis? DVT/PE? Acute renal Failure? Acute Renal Failure Requiring Renal Replacement Therapy? Acute Respiratory Distress Syndrome? Mild/Moderate/Severe? Tracheostomy required? Number of ventilator days? Number of ICU Days? Number of hospital days? Mortality within 28 days of admission? Mortality within 48 hours of admission? Extubation within 48 hours of admission? Neurologic Assessment: GCS at time of extubation: GCS at time of transfer out of ICU: GCS at hospital discharge:
East Multicenter Study Data Dictionary Preemptive APRV Study-Data Dictionary Entry Space Standard Study Questions: Admission Date Admission Time Age Gender Specifics of Injury: Time of Injury Mechanism of Injury Blunt ISS Injuries AIS Chest Initial GCS Penetrating Intubation: Time of Intubation Location of Intubation Initial Ventilator Settings Date/Time of Initiation Definition/Instructions Admission date of the patient enrolled Admission time of the patient enrolled Age of the patient enrolled Gender of the patient enrolled Estimated time the injury occurred Single choice for best description of blunt mechanism MVC (motor vehicle collision) Auto vs Pedestrian Fall Assault MCC (motorcycle collision) Machinery Other Single choice for best description of penetrating mechanism GSW (gunshot wound) Shotgun wound Stab wound Other Numerical value for calculated ISS (Injury Severity Score) All documented injuries discovered throughout hospitalization Numerical value for AIS of chest (Abbreviated Injury Score) GCS at time of presentation to facility (Glascow Coma Score) Time the patient enrolled was intubated Single choice for best description of location of intubation On scene Ambulance/Helicopter Trauma Bay ICU Ventilator settings prior to initiation of protocol Date/Time of initiation of protocol
Volume: Volume of crystalloid prior Volume of crystalloid infused prior to initiation of protocol Blood products prior Blood products infused prior to initiation of protocol prbc Volume Volume of prbcs prior to initiation of protocol FFP Volume Volume of FFP prior to initiation of protocol Platelet Volume Volume of Platelets prior to initiation of protocol Total Crystalloid infused Total volume of crystalloid infused while patient was intubated Total Blood Products Infused Total volume of blood product infused while intubated Total prbc Volume Total volume of prbcs infused while intubated Total FFP Volume Total volume of FFP infused while intubated Total Platelet Volume Total volume of platelets infused while intubated Admission Values: Hemoglobin Admission hemoglobin (g/dl) ABG Admission ABG (ph/pco 2/PO 2/HCO 3) Lactate Admission Lactate (mmol/l) Base Deficit Admission Base Deficit (mmol/l) BUN Admission BUN (mg/dl) Creatinine Admission Creatinine (mg/dl) Vitals Admission Vitals (temperature/heart rate/blood pressure/respiratory rate/spo2) P/F Ratio Admission PO 2/FiO 2 ratio Hospital Course Ventilator Settings and Changes Date/Time Date and time of ventilator changes per protocol Pulse Ox Pulse oximetry at time of each ventilator change EtCO2 End Tidal CO2 at time of each ventilator change ABG ABG (if obtained) at time of each ventilator change Ventilator Settings Change made at that time to the ventilator, per protocol Vasopressors and Inotrope Usage Date/Time Date and time of initiation of change in drip settings Vasopressor/Inotrope Name of vasopressor and or inotrope used Dose Dose at time of change of each vasopressor and inotrope Renal Function Date/Time BUN/Cr UOP Date and time of lab draw The value of both BUN and Creatinine at time of lab draw On the date specified, did urine ouput drop to less than 0.5mL/kg/hr for more than 6 consecutive hours?
Compliations: Hospital Acquired Pneumonia Ventilator Associated Pneumonia Blood Stream Infection Catheter Associated Urinary Tract Infection Sepsis DVT/PE Acute Renal Failure Confirmed by the presence of the following 48 hours after hospitalization 1. Purulent sputum 2. Associated systemic evidence of infection a. WBC >11 or <4 b. Fever >38 C 3. 2 or more serial CXR with new or progressive and persistent infiltrates, consolidation, or cavitation 4. BAL, mini BAL, or sterile endotracheal specimen with a. Limited number of epithelial cells b. WBC (2-3+) c. Dominant organism(s) identified on gram stain or culture with quantitative culture>100,000 cfu/ml Hospital acquired pneumonia (as defined above) in a patient who was intubated and ventilated at the time of or within 48 hours of onset of pneumonia Positive blood cultures obtained from blood culture All of the following must be met 1. Patient has had an indwelling catheter within 7 days before urinary culture 2. Positive urine culture, that is 10 5 microorganisms/ml of urine with no more than two species of microorganisms 3. Urine culturehas 10wbc/hpf Confirmed infectious process AND 2 or more of the following 1. Body temperature <36 C or >38 C 2. Heart rate > 100bpm 3. Respiratory rate >20 breaths per minute or, on blood gas, PaCO 2 of less than 32 mm Hg 4. White blood cell count <4 or >12 or greater than 10% immature WBCs Deep vein thrombosis or pulmonary embolism with radiographic confirmation (ultrasound, computed tomography, venography) Defined as one of the following 1. An increase in serum creatinine by >0.3mg/dL within 48 hours 2. An increase in SCr to >1.5 times baseline which has occurred in the previous 7 days 3. Urine volume <0.5mL/Kg/hr for 6 hours or more
Acute Renal Failure Requiring Renal Replacement Therapy As defined by the intiation of continuous or intermittent dialysis Acute Respiratory Distress Syndrome As defined by the following 1. Within 1 week of known clinical insult or new or worsening respiratory symptoms 2. Bilateral opacities on chest radiographic images not fully explained by effusions, lobar/lung collapse or nodules 3. Respiratory failure not fully explained by cardiac failure or fluid overload Mild/Moderate/Severe Extubation within 48 hrs Tracheostomy Required: Number of Ventilator Days: Number of ICU Days: Number of Hospital Days: Mortality within 28 days of admission Mortality within 48 hours: Choose one based on the following definitions Mild: P/F 200-300 Moderate: P/F 100-200 Severe: P/F <100. Was the patient extubated within 48 hours of Admission? Number of days patient enrolled remained on the ventilator with admission as day 1. Number of days patient enrolled remained in the ICU with admission as day 1. Number of days patient enrolled remained in the hospital with admission as day 1. Neurologic Assessment: GCS at time of extubation GCS at time of transfer GCS at time of discharge GCS immediately following extubation GCS at time of transfer out of the ICU GCS at time of hospital discharge