Hemodynamic Resuscitation and Monitoring in Early Sepsis
- Conditions
- Septic Shock
- Registration Number
- NCT04143035
- Lead Sponsor
- Tata Memorial Centre
- Brief Summary
"Hemodynamic Resuscitation and Monitoring in Early Sepsis (HERMES Study)" involves recording of patient's medical data related to that has been collected as part of his/her routine medical care in ICU.
Presently there is no data from Indian ICUs on the way patients in early sepsis are resuscitated and monitored. There may exist a wide variation in clinical practice. The investigators would like to conduct an observational study in various levels of Indian ICUs, to prospectively collect data on adult patients admitted to ICU with early sepsis in a 60-day window period. Investigator would like to study the hemodynamic resuscitation and monitoring performed in these patients. In addition, Investigator would like to identify factors associated with improved outcomes and achieving the goals of the sepsis bundles in one, three and six hours.
The objectives of the study is to capture the patient characteristics and hemodynamic resuscitation and monitoring practices in patients presenting with early sepsis and hypotension to Indian ICUs
Investigator plan to recruit 50 -100 centers nationwide. Each center will be asked to collect data from at least 10 patients in a maximum time window of 60 days. A convenience sample of minimum 500 patients presenting to ICU with suspected sepsis and hypotension will be taken.
Each Centre will guarantee the integrity of data collection and ensure timely completion of the case record forms. Each center will select a 60 day window period for patient recruitment. The start date may be anytime any time between 1st August to 15th October 2019. Therefore, the recruitment window period will end for a respective centre, anytime between 30th September and 14th December 2019, depending on the start date. All consecutive patients in the 60-day period will be screened and those eligible will be enrolled.
This is an ISCCM(Indian Society of Critical Care Medicine) Research Committee funded study. The ISCCM will fund the Principal Investigator for all expenses related software development, website hosting, secretarial assistance and miscellaneous expenses related to the conduct of the study, data analysis and publication. No funding will be given to the investigators from the various participating centers for contributing data.
- Detailed Description
INTRODUCTION Septic shock is the most commonly occurring of all types of shock.The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) defines septic shock as a subset of sepsis in which particularly profound circulatory, cellular, and metabolic abnormalities are associated with a greater risk of mortality than with sepsis alone. Patients with septic shock can be clinically identified by a vasopressor requirement to maintain a mean arterial pressure of 65 mm Hg or greater and serum lactate level greater than 2 mmol/L (\>18 mg/dL) in the absence of hypovolemia. This combination is associated with hospital mortality rates greater than 40%.
The "sepsis bundle" has been central to the implementation of the Surviving Sepsis Campaign (SSC) from the first publication of its evidence-based guidelines in 2004 through subsequent editions. Developed separately from the guidelines publication by the SSC, the bundles have been the cornerstone of sepsis quality improvement since 2005. An updated version was published in 2016 "Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock". There is compelling nature of the evidence in the literature which demonstrates an association between compliance with bundles and improved survival in patients with sepsis and septic shock. This has led to the adoption of the SSC measures by the National Quality Forum (NQF) and other departments. The important relationship between the bundles and survival was confirmed in a publication from this initiative.
The Surviving Sepsis Campaign released an updated one-hour sepsis bundle, which combines recommendations listed in the three-hour and six-hour bundles. This includes 5 elements: 1. measuring lactate levels 2. obtaining blood cultures before administering antibiotics 3. administering broad-spectrum antibiotics 4. fluid resuscitation for hypotension or lactate level ≥ 4 mmol/L and 5. use of vasopressors for hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg.
Presently there is no data from Indian ICUs on the way patients in early sepsis are resuscitated and monitored. There may exist a wide variation in clinical practice.The Investigator would like to conduct an observational study in various levels of Indian ICUs, to prospectively collect data on adult patients admitted to ICU with early sepsis in a 60-day window period. Investigator would like to study the hemodynamic resuscitation and monitoring performed in these patients. In addition, investigator would like to identify factors associated with improved outcomes and fulfilling the goals of the one hour SSC bundles within one, three and six hours in patients with sepsis and septic shock.
OBJECTIVES
1. To capture the patient characteristics and hemodynamic resuscitation and monitoring practices in patient presenting with early sepsis and hypotension to Indian ICUs
2. To determine various factors associated with improved survival in patients with septic shock
3. To determine factors associated with achieving the 1 hour, 3 hour and 6-hour resuscitation goals of the sepsis bundle in patients with septic shock
METHODS Study design- Prospective observational multi-center national cohort study.
Patient Recruitment
ISCCM members across India will be contacted to register their ICUs in the study, through emails sent from the ISCCM Research committee. Repeated emails will be sent over a two-month period. Hospitals with more than one ICU can enroll each of their ICUs separately. Each ICU will need to contribute a minimum of 10 adult patients with sepsis and hypotension in a 60 day window period.
Each center will designate a maximum of two local coordinators (PI and Co-PI) who will provide scientific and structural leadership in their centers. They will ensure that all local necessary ethical and regulatory approvals are obtained before the start of patient inclusion.
Local coordinators will guarantee the integrity of data collection and ensure timely completion of the case record forms. Each center will select a 60 day window period for patient recruitment. The start date may be anytime any time between 1st August to 15th October 2019. Therefore, the recruitment window period will end for a respective centre, anytime between 30th September and 14th December 2019, depending on the start date. All consecutive patients in the 60-day period will be screened and those eligible will be enrolled.
Data Collection
1. There will be no direct patient contact or intervention. Local coordinators will guarantee the integrity of data collection and ensure timely completion of CRFs (case record forms). Date related to the following will be collected prospectively from the charts:
2. Patient demographic data e.g. age, sex, comorbidities, likely source of sepsis
3. Total number of ICU patients, patients with sepsis and septic shock admitted to the ICU in the 60 days period
4. Patient clinical examination findings and severity of illness
5. Details of hemodynamic monitoring and other systemic monitoring and therapy performed in ICU e.g. fluid bolus, vasopressor agents, monitoring devices used, hemodynamic variables measured, mechanical ventilation, dialysis etc. in the first 3 days of ICU admission
6. Antibiotics administered and details of microbiology examinations
7. Adjunct therapies initiated for sepsis
8. ICU, hospital and 28-day mortality
Sample size The primary endpoint of study was to determine the incidence of ICU mortality in patients with septic shock admitted to Indian ICUs. The sample size calculation was done on the basis of INDICAPS I(Indian Intensive Care Case Mix and Practice Patterns Study-I) Study data (IJCCM April 2016). In this study the ICU mortality incidence was found to be 45% in patients with septic shock. Assuming the incidence rate found in this study, a sample size of 401 produces a two-sided 95% confidence interval with a width equal to 0.100 when the sample proportion is 0.450. Sample size calculation was done using PASS software. To account for attrition, Investigator will take a sample size of at least 450 patients. Investigator plan to recruit 50 -100 centers nationwide. Each center will be asked to collect data from at least 10 patients, hence investigator should be able to meet this target of \>450 patients.
Statistical analysis The primary objective of the study is to determine the patient characteristics and hemodynamic resuscitation and monitoring practices in patient presenting with early sepsis and hypotension to Indian ICUs which will be analyzed using descriptive statistics. To determine various factors associated with improved survival in patients with septic shock investigator will use the Fisher's exact test or Pearson's χ2 test. Univariable and Multivariable logistic regression models will be developed to assess the independent effects on ICU mortality. To determine factors associated with achieving the 1 hour SSC Sepsis resuscitation bundle in 1 hour, 3 hours and 6-hours in patients with sepsis and septic shock will be assessed by Fisher's exact test or Pearson's χ2 test. Univariable and Multivariable logistic regression models will be developed to assess the independent effects on ICU mortality of the 1 hour, 3 hour and 6-hour resuscitation goals of the sepsis bundle in patients with sepsis and septic shock. The overall performance of the internally validated model will be assessed using Nagelkerke's R2 (R squared in logistic regression). The higher Nagelkerke's R2, the greater the strength of the model. The ability of the models to identify ICU mortality will be quantified as the area under the receiver operating characteristic curve (AUC). The AUC ranges from 50% to 100%, indicating no discriminative capacity to perfect discriminative capacity. The agreement between predicted probabilities and observed frequencies of the outcome will be assessed by visually inspecting the calibration plot. Last, the Hosmer and Lemeshow goodness-of-fit statistic will be computed as a quantitative measure of accuracy. A high outcome of this statistic is related to a low p-value, which indicates a poor fit. All analysis will two sided, and significance will set at a p-value of 0.05. Statistical analyses will be performed using SPSS (the statistical package for social sciences) IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, New York: IBM Corp and R studio (version 1.2).
INSTITUTIONAL ETHICS COMMITTEE (IEC) APPROVAL The local hospital investigators should ensure that all necessary local ethical and regulatory approvals are obtained if required, before the start of the study in their institution.
CONSENT FOR DATA COLLECTION This is an observational study and involves capture of data from the patient charts. There is no direct patient contact or intervention, hence written, informed consent is not mandatory. However, if required by the institution, consent may be taken from the patients legally accepted representative (LAR). Sample short consent forms for patient data capture will be provided by the PI in English, Hindi and Marathi. This may be translated in various regional languages as required by the local investigator
STUDY FUNDING This is an ISCCM Research Committee funded study. The ISCCM will fund the Principal Investigator institution for all expenses related software development, website hosting, secretarial assistance and miscellaneous expenses related to the conduct of the study, data analysis and publication (against actual bills). No funding will be given to the investigators from the various participating centres for contributing data.
DATA STORAGE AND OWNERSHIP The Principal Investigator will have ownership of the data. The data will be stored in the Principal Investigators department at Tata Memorial Hospital, Mumbai for 10 years.
PUBLICATION AND AUTHORSHIP POLICY The main results of study will be published in a peer-reviewed medical journal. Authorship policy will follow the International Committee of Medical Journal Editors (ICMJE) recommendations. Authorship will be considered based on contributions the study design and protocol development, recruitment of patients, data acquisition and cleaning, analysis and interpretation of the data, manuscript writing and final approval of the version to be published and agreement to be accountable for all aspects of the work, in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Steering Committee - Members of the Steering Committee will include 7 members from the Principal Investigators center and 8 -10 experts from across the country. They will be involved and provide active guidance from inception till publication of the study.
Writing committee and main author list - Members of the steering committee and Principal Investigator from the top 3 centers with highest number of patient recruitment.
The Principal Investigator and Co-Principal Investigator from each participating ICU will be in the list of study collaborators and their names will be in the publication. The names of all the investigators will be indexed in PubMed depending on the journal policy.
SECONDARY ANALYSES After publication of the primary results, on request, the pooled dataset will be available for investigators for secondary analysis, after judgment and approval of scientific quality and validity by the steering committee. Before submission, the final version of all manuscripts related to the study dataset must be approved by the steering committee. The members of the writing committee will be authors of the publications derived from the study dataset.
Recruitment & Eligibility
- Status
- ACTIVE_NOT_RECRUITING
- Sex
- All
- Target Recruitment
- 500
Not provided
Not provided
Study & Design
- Study Type
- OBSERVATIONAL
- Study Design
- Not specified
- Primary Outcome Measures
Name Time Method ICU Mortality throughout ICU stay till discharge (up to 2 months) Overall ICU Mortality due to septic shock with hypotension
Completing the elements of the one hour SSC sepsis bundle in one 1 hour 1 hour after admission upto 60 days from the study start date in respective study site (60 days) Identify factors associated with improved outcomes and fulfilling the goals of the one hour Surviving Sepsis Campaign (SSC) bundles within one, three and six hours in patients with sepsis and septic shock and to identify compliance with the one hour SSC bundle guidelines The Surviving Sepsis Campaign released an updated one-hour sepsis bundle, which combines recommendations listed in the three-hour and six-hour bundles. This includes 5 elements: 1. measuring lactate levels 2. obtaining blood cultures before administering antibiotics 3. administering broad-spectrum antibiotics 4. fluid resuscitation for hypotension or lactate level ≥ 4 mmol/L and 5. use of vasopressors for hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg
- Secondary Outcome Measures
Name Time Method Hospital mortality throughout the hospital stay till discharge in the respective study site (up to 3 months) Over all mortality during the hospital stay
Completing the elements of the one hour SSC sepsis bundle in one, three and six hours 1 hour, 3 hour and six hour after admission upto 60 days from the study start date in the respective study site (60 days ) Identify factors associated with improved outcomes and fulfilling the goals of the one hour Surviving Sepsis Campaign (SSC) bundles within one, three and six hours in patients with sepsis and septic shock and to identify compliance with the one hour, three hour and six hour SSC bundle guidelines The Surviving Sepsis Campaign released an updated one-hour sepsis bundle, which combines recommendations listed in the three-hour and six-hour bundles. This includes 5 elements: 1. measuring lactate levels 2. obtaining blood cultures before administering antibiotics 3. administering broad-spectrum antibiotics 4. fluid resuscitation for hypotension or lactate level ≥ 4 mmol/L and 5. use of vasopressors for hypotensive during or after fluid resuscitation to maintain MAP ≥ 65 mm Hg
28-day mortality From ICU admission to 28 days in the respective study site (up to 3 months) Over all mortality from ICU admission day to till 28 day
Trial Locations
- Locations (241)
J N Medical College & Hospital
🇮🇳Alīgarh, India
Nayati Hospital - Trauma & Acute Care Centre
🇮🇳Agra, India
Rainbow Hospitals
🇮🇳Agra, India
Saideep Healthcare and Research Pvt Ltd
🇮🇳Ahmednagar, India
Narayana Multispeciality Hospital
🇮🇳Ahmedabad, India
Fortis Escorts Hospital Amritsar
🇮🇳Amritsar, India
Aster R V Hospital
🇮🇳Bengaluru, India
Apollo Hospitals
🇮🇳Nashik, India
Kamalnayan Bajaj hospital
🇮🇳Aurangabad, India
Bhagwan Mahaveer Jain Hospital
🇮🇳Bangalore, India
Columbiaasia Referral Hospital, Yeshwantpur
🇮🇳Bangalore, India
Health care Global (HCG)
🇮🇳Bangalore, India
Geeta Hospital and research centre
🇮🇳Barnagar, India
Care Hospitals
🇮🇳Bhubaneswar, India
Care Hospital
🇮🇳Bhubaneswar, India
Regal Hospital
🇮🇳Bengaluru, India
BR Life Kalinga Hispital
🇮🇳Bhubaneswar, India
Apollo Hospitals Enterprise limited
🇮🇳Chennai, India
Kovai Medical Center Hospital and Research
🇮🇳Coimbatore, India
Ashwini Hospital
🇮🇳Cuttack, India
SCB Medical College
🇮🇳Cuttack, India
Muthukrishnan Periasamy
🇮🇳Erode, India
Sri Ramachandra Hospital
🇮🇳Chennai, India
Sri Ramchandra Medical Centre
🇮🇳Chennai, India
Lalitha Super Specialities Hospital
🇮🇳Guntur, India
Narayana Super Specialty Hospital
🇮🇳Gurgaon, India
Apollo hospitals
🇮🇳Guwahati, India
Health City
🇮🇳Guwahati, India
Aig Hospitals, Gachibowli
🇮🇳Hyderabad, India
Goodluck Hospital
🇮🇳Cuttack, India
City Hospital
🇮🇳Gorakhpur, India
Samistha Hospital and Research Institute
🇮🇳Guntur, India
Medanta Medicity
🇮🇳Gurgaon, India
Ayursundra Superspecialty hospital
🇮🇳Guwahati, India
Dispur Hospitals pvt Ltd
🇮🇳Guwahati, India
Nemcare Hospital
🇮🇳Guwahati, India
Qrg Healthcity
🇮🇳Faridabad, India
Medanta the medicity
🇮🇳Gurgaon, India
VPS Medeor Hospital
🇮🇳Gurgaon, India
Santhi Hospital
🇮🇳Hosur, India
Aware Gleneagles Global Hospital
🇮🇳Hyderabad, India
CENTURY hospital
🇮🇳Hyderabad, India
Century Super Speciality Hospital
🇮🇳Hyderabad, India
Continental Hospitals
🇮🇳Hyderabad, India
Shubh Hospital
🇮🇳Jaipur, India
All India Institute of Medical Sciences, jodhpur
🇮🇳Jodhpur, India
AMRI Hospital Mukundapur
🇮🇳Kolkata, India
Fortis Hospital Anandapur
🇮🇳Kolkata, India
Yashoda Hospital
🇮🇳Hyderabad, India
Choithram hospital
🇮🇳Indore, India
Shree Krishna Hospital
🇮🇳Karamsad, India
Apollo Gleneagles Hospital
🇮🇳Kolkata, India
Peerless Hospitex Hospital and Research Center Limited
🇮🇳Kolkata, India
Kasturba medical college, Manipal
🇮🇳Manipala, India
Smvd Narayana Superspeciality Hospital
🇮🇳Jammu, India
Ved Hospital
🇮🇳Kalyan, India
Sankalpa hospital
🇮🇳Khammam, India
Amrita institute of Medical Sciences
🇮🇳Kochi, India
Bellevue Clinic
🇮🇳Kolkata, India
Nayati medicity hospital
🇮🇳Mathura, India
Fortis Hospital
🇮🇳Noida, India
Holy Family Hospital
🇮🇳Mumbai, India
Nanavati Hospital Icu-1
🇮🇳Mumbai, India
Nanavati Hospital Icu-3
🇮🇳Mumbai, India
Nanavati Hospital
🇮🇳Mumbai, India
s.l.Rahej hospital- a fortis associate
🇮🇳Mumbai, India
Tata Memorial Hospital (SICU)
🇮🇳Mumbai, India
Wockhardt Hopsital South Mumbai
🇮🇳Mumbai, India
Cauvery Heart and multispeciality hospital
🇮🇳Mysore, India
Narayana Medical College Icu-1
🇮🇳Nellore, India
Narayana Medical College
🇮🇳Nellore, India
Batra Hospital
🇮🇳New Delhi, India
Sri Balaji Action Medical Institute
🇮🇳New Delhi, India
Venkateshwar Hospital
🇮🇳New Delhi, India
Prabhat Kumar
🇮🇳Patna, India
Nanavati hosptial
🇮🇳Mumbai, India
Tata Memorial Hospital (FICU)
🇮🇳Mumbai, India
Jss Hospital
🇮🇳Mysore, India
Pd Hinduja National Hospital and Mrc
🇮🇳Mumbai, India
Sir H N Reliance Foundation Hospital
🇮🇳Mumbai, India
Rahate Surgical Hospital and Iccu
🇮🇳Nagpur, India
Indraprastha apollo hospitals
🇮🇳New Delhi, India
Suasth Health Care
🇮🇳Mumbai, India
Aditya Hospital
🇮🇳Nagpur, India
Dew medicare and Trinity Hospital
🇮🇳Nagpur, India
Orange City Hospital And Research Institute
🇮🇳Nagpur, India
Meditrina Institute Of Medical Scineces
🇮🇳Nagpur, India
Shree Hospital and Critical Care Centre
🇮🇳Nagpur, India
National Burns Centre
🇮🇳Navi Mumbai, India
Northern railway central hospital
🇮🇳New Delhi, India
All India Institute of Medical Sciences Patna
🇮🇳Patna, India
Indira Gandhi Institute of Medical Sciences
🇮🇳Patna, India
Shree Narayana Hospital
🇮🇳Raipur, India
Kiran Hospital
🇮🇳Surat, India
Trichy Srm Medical College Hospital & Research Centre
🇮🇳Trichinopoly, India
Kerala Institute of Medical sciences
🇮🇳Trivandrum, India
Bhagwan Mahavir Medica Superspecialty Hospital
🇮🇳Ranchi, India
Sagarshree Hospital
🇮🇳Sāgar, India
Sheri Kashmir Institute of Medical Sciences
🇮🇳Srinagar, India
Nagarjuna hospital
🇮🇳Vijayawada, India
Siddaganga hospital and research centre
🇮🇳Tumuluru, India
Sterling Hospitals
🇮🇳Vadodara, India
Homi Bhaba Cancer Hospital & Pandit Madan Mohan Malviya Cancer Centre,Tata Memorial Centre,Varanasi
🇮🇳Varanasi, India
S S Hospital BHU VARANASI
🇮🇳Varanasi, India
Arnam Hospital
🇮🇳Wardha, India
St Ann Hospital
🇮🇳Visakhapatnam, India
Samraksha super speciality
🇮🇳Warangal, India
Gudage Hospital
🇮🇳Bidar, India
Nanavati hospital ICU-2
🇮🇳Mumbai, India
Simhapuri Hospital
🇮🇳Nellore,, India
Sanjeevan Hospital
🇮🇳Pune, Maharashtra, India
Pims
🇮🇳Udaipur, Rajasthan, India
Galaxy care hospital
🇮🇳Pune, Maharashtra, India
Criticare Hospital and Research Institute
🇮🇳Nagpur, Maharashtra, India
Dayanand Medical College and Hospital
🇮🇳Ludhiyana, Panjab, India
kailash Hospital and heart Institute
🇮🇳Delhi, India
Emc hospital
🇮🇳Amritsar, India
Oriion Citicare Superspeciality Hospital
🇮🇳Aurangabad, India
BKL Walawalkar Hospital
🇮🇳Dervan, India
K.M.Memorial hospital and research centre
🇮🇳Bokāro, India
Royal Care Super Speciality Hospital
🇮🇳Coimbatore, India
Scb Medical College and Hospital
🇮🇳Cuttack, India
Billroth hospital
🇮🇳Chennai, India
Yashoda super specialty hospital, kaushambi
🇮🇳Ghāziābād, India
GBR super speciality hospitals
🇮🇳Guntur, India
South Central Railway Hospital ICU-1
🇮🇳Hyderabad, India
Shree krishna hospital ICU-1
🇮🇳Karamsad, India
AMRI Hospital, DHAKURIA
🇮🇳Kolkata, India
Tata Main Hospital
🇮🇳Jamshedpur, India
Medica Superspecialty Hospital
🇮🇳Kolkata, India
Dr L H HIRANANDANI HOSPITAL
🇮🇳Mumbai, India
Fortis hiranandani hospital
🇮🇳Mumbai, India
Global Hospital,Parel
🇮🇳Mumbai, India
Batra Hospital & Medical Research Center
🇮🇳New Delhi, India
Promhex Multispeciality Hospital
🇮🇳Noida, India
Shree Giriraj Multispecialty Hospital
🇮🇳Rajkot, India
Shree Giriraj Multispeciality hospital
🇮🇳Rājkot, India
Shree Sardar Smarak Hospital
🇮🇳Surat, India
Believers Church Medical College and Hospital
🇮🇳Tiruvalla, India
Kamlesh Kanwar Shekhawat
🇮🇳Udaipur,, Rajasthan, India
AIIMS Patna
🇮🇳Patna, Bihar, India
Anant Institute of Medical Sciences
🇮🇳Jabalpur, Madhya Pradesh, India
Eternal Hospital
🇮🇳Jaipur, Rajasthan, India
Dr.Rela Institute and Medical Centre
🇮🇳Chennai, India
Dr. Ram Manohar Lohia Hospital ,New Delhi
🇮🇳Delhi, India
Paras Global Hospital
🇮🇳Darbhanga, India
Dr. Ram Manohar Lohia Hospital
🇮🇳Delhi, India
Sir Ganga Ram Hospital
🇮🇳Delhi, India
Pushpawati Singhania Research Institute
🇮🇳Delhi, India
Medanta the medicity hospital
🇮🇳Gurgaon, India
Gnrc Hospitas, Dispur
🇮🇳Guwahati, India
Care hospital and institute of medical sciences
🇮🇳Hyderabad, India
Gleneagles Global Hospital
🇮🇳Hyderabad, India
Virinchi Hospital
🇮🇳Hyderabad, India
South Central Railway Hospital
🇮🇳Hyderabad, India
Abha superspeciality hospital
🇮🇳Kanpur, India
Regency hospital ltd tower 1
🇮🇳Kanpur, India
Apollo speciality hospital
🇮🇳Madurai, India
Cheema Medical Complex
🇮🇳Mohali, India
Fortis Hospital, Shalimar Bagh
🇮🇳New Delhi, India
BLK hospital
🇮🇳New Delhi, India
GB Pant Institute of Post Graduate Medical Education & Research
🇮🇳New Delhi, India
Indraprastha Apollo Hospitals ICU-1
🇮🇳New Delhi, India
Max Super Specialty Hospital Patparganj
🇮🇳New Delhi, India
Jupiter Hospital
🇮🇳Pune, India
Vishwaraj Hospital & Research Centre
🇮🇳Pune, India
Sri balaji action medical institute ICU-1
🇮🇳New Delhi, India
Ruby Hall Clinic ICU-2
🇮🇳Pune, India
Sarvodaya hospital and research centre
🇮🇳Faridabad, Uttar Pradesh, India
All india institute of medical sciences
🇮🇳Patna, Bihar, India
Fortune Hospital
🇮🇳Kanpur, Uttar Pradesh, India
Purushottam das Savitri Devi Cancer center
🇮🇳Agra, India
Pushpanjali Hospital
🇮🇳Agra, India
Sterling hospital
🇮🇳Ahmedabad, India
Zydus Hospitals Ahmedabad
🇮🇳Ahmedabad, India
Ohm Trauma centre and critical care
🇮🇳Alīgarh, India
Mgm Medical College Hospital and Medical Centre Research Institute(McRi)
🇮🇳Aurangabad, India
Shraddha hospital and critical care center
🇮🇳Aurangabad, India
Cytecare Cancer Hospital
🇮🇳Bangalore, India
Shifaa hospital
🇮🇳Bangalore, India
Shri Ram Murti Smarak Institute of Medical Sciences
🇮🇳Bareilly, India
Mazumdar Shaw Medical Center
🇮🇳Bengaluru, India
St John's Medical College Hospital
🇮🇳Bengaluru, India
Amri hospital ICU -1
🇮🇳Bhubaneswar, India
AMRI Hospitals
🇮🇳Bhubaneswar, India
Amri Hospital
🇮🇳Bhubaneswar, India
Apollo Hospital
🇮🇳Bilaspur, India
Ayush Hospital
🇮🇳Bijapur, India
Apollo Hospital Icu-1
🇮🇳Bilaspur, India
MOSC Medical College
🇮🇳Cochin, India
Dodeja Hospital
🇮🇳Jabalpur, India
Apex Hospital
🇮🇳Jaipur, India
Shrimann Superspeciality Hospital
🇮🇳Jalandhar, India
Kripa Critical Care and Trauma Centre
🇮🇳Jalgaon, India
Manipal hospital
🇮🇳Jaipur, India
Vydehi Institute of Medical Sciences and Research Centre
🇮🇳Bengaluru, India
PGIMER
🇮🇳Chandigarh, India
Mgm Healthcare Ltd.
🇮🇳Chennai, India
Dharmshila Narayana Superspeciality Hospital
🇮🇳Delhi, India
Dr.Ramesh Cardiac and Multiplicity PVT LTD
🇮🇳Guntur, India
Apollo Hospitals Guwahati
🇮🇳Guwahati, India
Apollo Health City ICU-1
🇮🇳Hyderabad, India
Apollo health city
🇮🇳Hyderabad, India
Care hospitals banjara
🇮🇳Hyderabad, India
Krishna Institute of Medical Sciences
🇮🇳Hyderabad, India
Rainbow childrnes hospital
🇮🇳Hyderabad, India
shrimann superspeciality hospital ICU-1
🇮🇳Jalandhar, India
Tata Medical Center
🇮🇳Kolkata, India
Travancore medical college,medicity
🇮🇳Kollam, India
Govt.Medical college
🇮🇳Kottayam, India
King George's Medical University
🇮🇳Lucknow, India
Christian Medical College
🇮🇳Vellore, India
Manglam Hosp
🇮🇳Meerut, India
Metro Hospital and heart Institute
🇮🇳Meerut, India
MAX Superspecialty Hospital
🇮🇳Mohali, India
Asian Cancer Institute
🇮🇳Mumbai, India
Bhatia Hospital
🇮🇳Mumbai, India
Fortis Hospital Mulund
🇮🇳Mumbai, India
Fortis hospitals
🇮🇳Mumbai, India
Global Hospital
🇮🇳Mumbai, India
Gopalagowda Shanthaveri Memorial Hospital
🇮🇳Mysuru, India
Dr V E Tambe Critical Care
🇮🇳Nagpur, India
Blk Superspeciality Hospital
🇮🇳New Delhi, India
Fortis Escorts Heart Institute
🇮🇳New Delhi, India
Ojas hospital
🇮🇳Panchkula, India
Niramaya Hoapital
🇮🇳Pune, India
Ruby Hall Clinic Icu-1
🇮🇳Pune, India
Ramskrishna care hospital
🇮🇳Raipur, India
Sterling Hospital, Rajkot (A Division of Sterling Addlife India Private Limited)
🇮🇳Rajkot, India
Synergy superspeciality hospital
🇮🇳Rajkot, India
Abdul Waheed Mir
🇮🇳Srinagar, India
Bharati Vidyapeeth Deemed university and Medical College Hospital
🇮🇳Pune, India
Columbia Asia hospital
🇮🇳Pune, India
Vishwaraj Hospital& Research Center
🇮🇳Pune, India
Om Hospital
🇮🇳Raipur, India
Pt. J. N. M. Medical College
🇮🇳Raipur, India
Genesis Multispeciality Hospital
🇮🇳Rajkot, India
Breach Candy Hospital Trust
🇮🇳Mumbai, Maharashtra, India
Sir Sundar lal Hospital, IMS, BHU, Varanasi
🇮🇳Varanasi, Uttar Pradesh, India
Sir Sunderlal Hospital
🇮🇳Varanasi, Uttar Pradesh, India
Institute of Neurosciences Kolkata
🇮🇳Kolkata, India