Participants and data collection

We collected the number of patients being treated in the participating ICUs on the study day. Of these, those who received one or more fluid resuscitation episodes any time during the 24 hour study period were included. Patients less than 16 years of age were excluded.

Fluid resuscitation episodes were defined as an hour during which a patient received a specifically prescribed intravenous fluid bolus of any crystalloid or colloid solution; a continuous infusion of 5ml/kg/hr or greater of crystalloid and/or any dose of colloid by continuous infusion. This definition of continuous infusion of fluid was obtained by investigator consensus before the 2007 study and used in 2014 to draw consistent comparisons.

Using a standard case report form, data were collected on all patients who received fluid resuscitation present in the participating ICU for all or part of the 24-hour study day. Data was entered into an electronic data capture system (REDCap—Vanderbilt University, Tennessee, USA) [16] hosted at the George Institute for Global Health, Sydney, Australia, apart from Brazilian sites where the data capture system was hosted at Institute D’Or de Ensino e Pesquisa, Rio de Janerio, Brazil. Data were checked using pre-determined range limits and queries were resolved with the individual sites.

Patient data collected included demographics, admission source and diagnosis, severity of illness score (such as Acute Physiology And Chronic Health Evaluation (APACHE) II [17] or Simplified Acute Physiology Score (SAPS) II[18]), and number of days in the ICU (where the first day of ICU admission was designated as day 0).

For each episode of fluid resuscitation, the type of fluid infused; the indication(s) for the fluid defined as impaired perfusion or low cardiac output, ongoing bleeding, other non-haemorrhagic fluid losses, unit protocol, abnormal vital signs; the prescriber characteristics defined as resident, registrar, ICU specialist or nurse; the cardiovascular and respiratory component of the Sequential Organ Failure Assessment (SOFA) score;[19] physiological variables including heart rate, mean arterial pressure, central venous pressure; laboratory values including creatinine, bilirubin, lactate, albumin concentration; cumulative urine output and total fluid output in the previous complete hour; the use of mechanical ventilation and renal replacement therapy were recorded. The type of resuscitation fluid was classified as crystalloids (saline, buffered salt solutions or other crystalloids) or colloids (albumin, HES, gelatin, dextran solutions) (S1 File,S1 and S2 Tables).

Statistical analyses

All analyses were carried out using R statistical software package (R version 3.1.0 (2014-04-10).[20] As more than one type of fluid could have been administered during a resuscitation episode, proportions could add to more than 100%.

Comparison of patient and prescriber characteristics for administration of crystalloids or colloids were tested using a t-test or Wilcoxon rank-sum test for continuous data or Pearson’s chi-squared for categorical data as appropriate. Differences in proportions of crystalloids and colloids used in fluid resuscitation episodes between geographical regions were tested using generalised estimating equations (GEEs), accounting for clustering at the patient level.

Multivariate analyses using GEEs accounting for clustering at the patient level, were conducted to determine associations between patient demographics, clinical characteristics and the type of fluid administered. Initially, each factor of interest was examined separately to determine if there was an association with the administered fluid. Variables meeting a pre-determined level of statistical significance (p <0·1) with the administration of crystalloid or colloid were included in the final model. Associations were considered statistically significant if p <0·01. Results of the multivariate analysis are presented as adjusted odds ratios (OR) and 95% confidence intervals (CI). Details regarding categorical data and handling of missing data are provided in S1 File.

Determination of the secular trends of types of fluid resuscitation use between 2007 and 2014 was completed by comparing patterns of fluid use in sites that participated in both the 2007 and 2014 studies (Fig 1). For differences over time in proportions of fluid indication and by fluid prescriber, GEEs were used to account for repeated episodes. Differences in fluid proportions over time were also analysed using GEEs accounting for clustering at the patient level and presented as unadjusted OR and 95% CI. A p value of <0·05 was considered to be statistically significant. Multivariate analysis, using GEEs were conducted to determine the change in the administration of crystalloid or colloid between the 2007 and the 2014 sample with methods as described above. Further details on the secular trend multivariate analysis methods are provided in the S1 File.

We examined secular trends in crystalloid and colloid use in six predefined subgroups: geographic region; an admission medical or surgical diagnosis; in patients with and without a diagnosis of sepsis in the 24 hours prior to the study day; in patients with and without an admission diagnosis of trauma (with or without traumatic brain injury (TBI)); in patients with high versus low severity of illness 24 hours prior to fluid administration; the number of days in the ICU at the survey day. For each subgroup we assessed heterogeneity of effect between time points by adding an interaction term between the two time periods and the subgroup variable of interest. P-values for heterogeneity of <0·05 was considered to be statistically significant. Further details on subgroup definitions are provided in S1 File.

One pre-specified sensitivity analysis of the initial fluid resuscitation episode only was conducted for both the overall 2014 data and the secular trend data. GEEs were used accounting for clustering at a hospital level to determine the effect of patient clustering by episode and that the results generated were consistent with the main analysis.

Study management and site investigators

Fluid TRIPS Management Committee: Naomi Hammond, Colman Taylor, Laurent Billot, Maryam Correa, Simon Finfer, Parisa Glass, Bette Liu, John Myburgh, Anders Perner, Manoj Saxena, Nicola Watts

Fluidos Management Committee: Flavia Ribeiro Machado, Andre Gobatto, Thiago Lisboa, Luciano Cesar Pontes de Azevedo, Felipe Dal Pizzol, Jorge Ibrahim Salluh, Andre Miguel Japiassu, Antonio Tonete Bafi, Bruno Franco Mazza, Flavio Geraldo Resende Freitas, Glauco A. Westphal, Leandro Taniguchi, Ludhmila Abrahão Hajjar, Márcio Soares, Murillo Assumpção, Suzana Margarete Lobo, Danilo Teixeira Noritomi, Alexandre Biasi Cavalcanti, Fernando Bozza

International Liaison Committee: Naomi Hammond, Colman Taylor, You Zhong An, Peter Andrews, Fernando Bozza, Maryam Correa, Bin Du, Simon Finfer, Parisa Glass, Flavia Machado, Lauralyn McIntyre, John Myburgh, Niklas Nielsen, Konrad Reinhardt, Manoj Saxena, Frederique Schortgen, Anders Perner, Nicola Watts

Fluid TRIPS and Fluidos Site Investigators: Argentina: Hospital Británico de Buenos Aires—J Chertcoff, F Lascar; Hospital Dr Julio C. Perrando—, I Arovich, C Dellera, C Insaurralde, S Mora, T Robledo. Australia (Country Coordinator: Maryam Correa): Alfred Hospital—J Cooper; Austin Hospital—R Bellomo, G Eastwood, L Peck, H Young; Bendigo Hospital—J Edington, J Smith; Box Hill Hospital—N Kuruvilla; Bunbury Hospital—M Draper, R Krishnamurthy; Canberra Hospital—H Rodgers, F van Haren; Coffs Harbour Health Campus—R Azad; Concord Hospital—M Kol, H Wong; Dandenong Hospital—K Shepherd, S Vij; Epworth Healthcare—D McCallum, M Robertson; Flinders Medical Centre—S Bihari, E Matheson, K Schwartz; Joondalup Health Campus—D Hawkins, E O’Donoghue; Liverpool Hospital—K Bradshaw, S Micallef, K Rachakonda; Lyell McEwin Hospital—J Wood; Nepean Hospital—R Gresham, P Palejs, A Ritchie, I Seppelt; Royal Adelaide Hospital—M Chapman, S O’Connor, F Zhang; Royal Darwin Hospital—D Stephens, J Thomas; Royal North Shore Hospital—F Bass, S Bird, S Finfer, N Hammond, A O’Connor, E Yarad; Royal Perth Hospital—E Jenkinson, E Litton; Royal Prince Alfred Hospital—H Buhr, D Gattas, D Hutch; Sir Charles Gairdner Hospital—S Baker, B Roberts; St Vincent’s Hospital Melbourne—J Holmes, J Santamaria; The Geelong Hospital—N Orford, T Salerno; The Queen Elizabeth Hospital—J McIntyre, S Peake; Western Hospital—S Bates, C French; Belgium: University Hospital Antwerp—N Van Regenmortel; Ziekenhuis Netwerk Antwerpen ZNA Stuivenberg—A Jans, M Malbrain; Brazil (Country Coordinator: Flavia R Machado): Albert Sabin Hospital e Maternidade—SR Zajac; Associação Beneficente Hospital Unimar—A Campos, D de Albuquerque; Associação Hospitalar Beneficente São Vicente de Paulo—J Gomez; Casa de Caridade de Carangola—S Vaz; Casa de Saúde Campinas—B Campos, W Delgadinho; Casa de Saúde Santa Lúcia—RT Amâncio, VC Souza-Dantas; Clinica Campo Grande—V Damasceno, J dos Santos; Clinica Dom Rodrigo—F de Araújo, I do Nascimento; Complexo Hospitalar Ortotrauma de Mangabeira—F de Araújo, I do Nascimento; Fundação Doutor Amaral Carvalho—M Higashi, E Mattos; Fundação Pio XII- Hospital de Câncer de Barretos—CP Amendola, UVA Silva; Hospital São José –F Dal-Pizzol, C Ritter; Hospital 9 de julho—UTI 10a andar—MD D’Agostino; Hospital 9 de julho—UTI 11a andar—C Moreira; Hospital 9 de julho—UTI 1a andar—C Moreira; Hospital 9 de julho—UTI 8a andar—L da Cruz Neto; Hospital 9 de julho—UTI 9a andar—F Ganem; Hospital Adventista de Belém—ME de Oliveira, E Sobrinho; Hospital Adventista de Manaus—P Ferreira, R Rabelo; Hospital Alemão Oswaldo Cruz—R Cordioli, F Zampieri; Hospital Alvorada Brasília—ACC Cembranel, EJ Nascimento; Hospital Alvorada Taguatinga—RS Biondi, E Milhomem; Hospital Amecor—Unidade Coronariana—M Bley; Hospital Amecor—UTI Geral—M Bley; Hospital Anis Rassi—G Canedo, R Filho; Hospital Assunção—M Fukushima, L Miilher; Hospital Beneficência Portuguesa—UTI do Choque—S Houly; Hospital Brigadeiro—EC Maitan, OL Santarém; Hospital Carlos da Silva Lacaz—A Ferreira, E Ferreira; Hospital Casa de Saúde de Santos—P Rosateli, A Scazufka; Grupo Hospitalar Nossa Senhora da Conceição—W Nedel, VM Oliveira; Hospital Copa D'Or—CTI Amarelo—L Rabello, W Viana; Hospital Copa D'Or UPO 2 –AP Santos, W Viana; Hospital Copa D'Or—UTI Azul—L Tanaka, W Viana; Hospital Copa D'Or—UTI Pós-operatória—L Salles, AP Santos; Hospital Copa D'Or—CTI Verde—K Ebecken, W Viana; Hospital Copa D'Or—Neurointensiva—D Musse, L Rabello; Hospital Copa D'Or—UTI Lilás—L Rabello, L Tanaka; Hospital da Luz Vila Mariana—F Filho, F dos Santos Borges; Hospital da Restauração—K Monteiro, F Buarque; Hospital das Clínicas da Faculdade de Medicina da USP—UTI emergências clinicas—P Mendes, L Taniguchi; Hospital das Clínicas da Faculdade de Medicina de Botucatu—L de Stefano, A Gut; Hospital das Clinicas da Faculdade Ribeirão Preto—M Auxiliadora-Martins, ML Puga; Hospital das Clinicas da Universidade Federal de Minas Gerais—V Nobre; Hospital das Clínicas da Universidade Federal do Espirito Santo—LM Caixeta, PF Vassallo; Hospital das Clinicas de Porto Alegre—RB Moraes, J Vidart; Hospital de Base—Faculdade de Medicina de São Jose do Rio Preto—H Batista, SM Lobo; Hospital de Caridade Astrogildo de Azevedo—CB da Silva, C Kmohan; Hospital de Clínicas Gaspar Vianna—C da Rocha, H Reis; Hospital de Urgência—UTI geral 1 –D Pedroso, J Sobrinho; Hospital de Urgência—UTI geral 4 –S Faria; Hospital de Urgência—UTI neurológica 3 –J Sobrinho; Hospital de Urgência—UTI trauma 2 –S Faria, D Pedroso; Hospital Distrital Evandro Ayres de Moura—L Figueiredo, H Magalhaes; Hospital do Coração- MLP Romano, R Vasconcelos; Hospital do Coração do Brasil—H Araújo, M de Araújo; Hospital do Rim e Hipertensão—AT Bafi, FGR Freitas; Hospital do Servidor Público Estadual—S Luzzi, D Ortega; Hospital do Servidor Público Municipal de São Paulo—T Farhat; Hospital do Servidor Público Municipal de São Paulo—UTI 7a andar—KM Sato; Hospital do Subúrbio—J Motta, C Lins; Hospital do Trabalhador—A Rea-Neto, F Reese; Hospital Dom Hélder—RAF Gomes, ARA Macedo Junior; Hospital Dom Vicente Scherer—EM Rodrigues Filho, M Hadrich; Hospital e Maternidade Municipal Dr. Odelmo Leão Carneiro—C Arantes, MAS Toneto; Hospital e Maternidade Otaviano Neves—B Fernandino, A Pereira; Hospital e Pronto Socorro 28 de Agosto—L Cavalcante, A Matos; Hospital Ecoville—L Araújo, A Rea-Neto; Hospital Escola da Faculdade de Medicina de Jundiaí –E Ferreira; Hospital Estadual de Urgência e Emergência de Vitória—L Dornelas, L Tcherniacovsk; Hospital Estadual Getúlio Vargas—UTI 1 –A Rodrigues, K Schechter; Hospital Estadual Getúlio Vargas—UTI 2 –F Montesanto, B Vidal; Hospital Estadual Getúlio Vargas—UTI 3 –C Frambach, G Moralez; Hospital Estadual Getúlio Vargas—UTI 4 –F Callil, V Montez; Hospital Estadual Rocha Faria—CHF Ramos; Hospital Evangélico de Londrina—J Festti, C Grion; Hospital Evangélico de Sorocaba—A de Souza, M Marabezi; Hospital Federal dos Servidores do Estado RJ—M Bissoli, J Marques; Hospital Felício Rocho—D Fontes, C Ranyere; Hospital Fernandes Távora—A Batista, L Martins; Hospital e Maternidade Galileo—W Delgadinho, M Rocha; Hospital Geral de Fortaleza—UTI azul—C Feijó, V Araújo; Hospital Geral de Goiânia—D Pedroso, G Silva; Hospital Geral de Vitória da Conquista—M Martins, M Ribeiro II; Hospital Geral Dr. César Cals—A Justo, A Macedo; Hospital Goiânia Leste—M Nobrega, M Nobrega; Hospital Hélio Anjos Ortiz—H Junior, M Lazzarotto; Hospital IBR—J Andrade, L Souza; Hospital Estadual Ipiranga—S Fernandes, F Lombardi; Hospital Israelita Albert Einstein—TD Correa, M Assunção; Hospital Jardim Amália—C Arbex, M Arbex; Hospital Estadual Jayme Santos Neves—F dos Anjos Sad, E Stucchi; Hospital M Boi Mirim—A Andrade, C de Abreu Filho; Hospital Madre Regina Prottman—D Colodetti, M Rodrigues; Hospital Marcelino Champagnat—M de Oliveira, A Rea-Neto; Hospital Mario Lioni—P Galhardo, A Japiassú; Hospital Maternidade e Pronto Socorro Santa Lucia—R Bergo, F Dall’Orto; Hospital Maternidade São José –P Bernardes, R Figueiredo; Hospital Memorial São José –G Costa, K Monteiro; Hospital Moinhos de Vento—M Rosa, JHD Barth; Hospital Municipal de Paracatu—T Neiva, R de Souza; Hospital Municipal Dr. Munir Rafful—M Arbex, L de Oliveira; Hospital Municipal Irma Dulce—D Boni, MOG Douglas, Hospital Municipal Dr Jose Soares Hungria—K Conde, N Quintino, Hospital Municipal Padre Germano Lauck—R Almeida, J Fuck, Hospital Municipal Pedro II—E Paranhos, J Soares; Hospital Municipal Santa Isabel—A de Carvalho, C Tavares; Hospital Municipal São José –D Possamai, G Westphal; Hospital Nereu Ramos—E Berbigier, I Maia; Hospital Norte D'Or—J Pinto, S Sant’Anna; Hospital Nossa Senhora da Conceição—JM de Araújo, F Schuelter-Trevisol; Hospital Nossa Senhora dos Prazeres—A Gargioni, R Gargioni; Hospital Nossa Senhora Monte Serrat—MAP Alves; Hospital Novo Atibaia—A Bemfica, R Franco; Hospital Ortopédico—L da Silva, M Nobrega; Hospital Paulistano—I Campos, DT Noritomi; Hospital Paulo Sacramento—ELA Ferreira; Hospital PIO XII de São José dos Campos- Unidade Coronariana—M Durval, A Silva; Hospital Português—R Hermes, O Messeder; Hospital Primavera—J Feijó, E Nogueira; Hospital Professor Edmundo Vasconcelos—E Jodar, R Pereira; Hospital Regional de Sousa—P da Silveira, A Lunguinho; Hospital Regional de Itapetininga São Camilo—V Irineu, R Seabra; Hospital Regional de Jundiaí –G Cavalcanti, M Leão; Hospital Regional de Presidente Prudente—GN Betônico, LA Garcia; Hospital Regional de Samambaia—UTI 1 –F Amorim, C de Carvalho; Hospital Regional de Samambaia—UTI 2 –S Margalho, F Santos; Hospital Renascentista—D Beraldo, R dos Santos; Hospital Samaritano Rio de Janeiro—J Freitas, R Lima; Hospital Samaritano São Paulo—UTI 6a andar—B Mazza, S Almeida, Hospital Samaritano São Paulo—3a andar—B Mazza, R Rocha; Hospital Samaritano Joao Pessoa—P Gottardo, C Mendes; Hospital Santa Helena—R Narciso, S Pantaleão; Hospital Santa Isabel—K Gerent; Hospital Santa Izabel—R Marco, D Vinho; Hospital Santa Juliana—EMV Troncoso, KLN Vilassante; Hospital Santa Lúcia—A Ventura, M da Silva; Hospital Santa Maria—M Nobrega, F Oliveira; Hospital Santa Maria—Intensibarra—I Santiago, A Lima; Hospital Santa Rita—F da Costa, M Vilela; Hospital Santa Rita—T Lisboa, A Torelly; Hospital São Camilo Ipiranga—M Dutra, F Giannini; Hospital São Camilo Pompéia—A Ramacciot, AT Maciel; Hospital São Francisco de Assis—GA da Silva, M da Silva; Hospital São Joao de Deus—G Gussen, M Rocha; Hospital São Lucas—UTI cirúrgica—C Santos, T Smith; Hospital São Lucas—UTI clínica—A Sobrinho, T Smith; Hospital São Lucas da PUCRS—S Baldiserotto, M Moretti; Hospital São Marcos—UTI A—W Dantas, L Ishiy; Hospital São Marcos—UTI B—W Dantas, L Ishiy; Hospital São Mateus—JG Moreira Filho; Hospital Saúde da Mulher—N Machado, L Rezegue; Hospital Sepaco—AT Bafi, ES Pacheco; Hospital SOS Cárdio—F Aranha, R Saorin; Hospital Tereza Ramos—K de Paula, R Waltrick; Hospital Total Cor—A Batista, P de Barros e Silva; Hospital Uniclinic—M Serpa, J Terceiro; Hospital Unimed ABC—MOG Douglas, R Rosenblat; Hospital Unimed de Belo Horizonte—A Barbosa, C Nogueira; Hospital Unimed de Limeira—A de Carvalho, L Paciência; Hospital Unimed de Macaé —JT Passos, PTS Almeida; Hospital Unimed de Manaus—WO Filho, MM Lippi; Hospital Unimed Rio de Janeiro—M Assad, F Miranda; Hospital Unimed Rio de Janeiro—UTI cardio—R Gomes, P Nogueira; Hospital Unimed Salto—MAP Alves; Hospital Universitário Cajuru—V Bernardes, L Tannous; Hospital Universitário Ciências Médicas—R Dutra, G Mirachi; Hospital Universitário da Universidade Federal de Juiz de Fora—BV Pinheiro, EV Carvalho; Hospital Universitário da Universidade Federal de São Paulo—UTI Clínica Médica—H Guimaraes, L Vendrame; Hospital Universitário da Universidade Federal de São Paulo—UTI geral—F Machado, A Nascente; Hospital Universitário da Universidade Federal de São Paulo—UTI neuro—F Machado, J Polezei; Hospital Universitário da Universidade Federal de São Paulo—UTI Pronto Socorro—AFT de Góis, KMC Teixeira; Hospital Universitário da Faculdade de Medicina de Jundiaí —G Cavalcanti, M Leão; Hospital Universitário de Maringá –A Germano, S Yamada; Hospital Universitário de Santa Cruz do Sul—P de Moraes, R Foernges; Hospital Universitário de Santa Maria—L Garcia, S Ribeiro; Hospital Universitário Getúlio Vargas—WO Filho, A Matos; Hospital Universitário Júlio Müller—D Castiglioni, G da Silva; Hospital Universitário Lauro Wanderley—P Gottardo, C Mendes; Hospital Universitário Maria Aparecida Pedrossian—S Pinto; Hospital Universitário São Francisco de Paula—M Guerreiro, L Teixeira; Hospital Universitário -Universidade Federal Grande Dourados—M Matsui, E Neto; Hospital Vila da Serra—F Anselmo, H Urbano; Hospital Vita Batel—R Deucher, A Rea-Neto; Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo—J Ferreira, E Costa; Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo—REC—FRBG Galas, LA Hajjar; Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo—FG Lima, VRB Benites; Instituto de Infectologia Emílio Ribas II—R Borba, M Douglas; Instituto de Ortopedia e Traumatologia—CPP Castro, AB Saraiva; Instituto de Pesquisa Clínica Evandro Chagas—IPEC / FIOCRUZ—FA Bozza, A Japiassú; Instituto do Câncer do Estado de São Paulo—JP Almeida, LA Hajjar; Instituto Estadual do Cérebro Paulo Niemeyer—C Righy, B Goncalves; Instituto D'Or de Ensino e Pesquisa—G Viana, A Reis; Instituto Latino Americano de Sepse—F Carrara, A Carvalho Junior; Instituto Nacional de Cardiologia—M de Freitas, R Felipe; Instituto Ortopédico—L Caetano, M Nobrega; Instituto de Pesquisa Hospital do Coração—D de Moraes Paisani; Irmandade de Misericórdia de Guaxupé –SA Bezerra, DRB Pereira; Irmandade Misericórdia Hospital Santa Casa de Monte Alto—L Cassimiro, W Filho; Lifecenter—M Hermeto, B Pinto; Samur—L Ferraz, L Melo; Santa Casa de Angra dos Reis—V Bogado, S Silva; Santa Casa de Belém do Pará –R Batista, N Fonseca; Santa Casa de Belo Horizonte—P Correia, G Reis; Santa Casa de Caridade de Diamantina—MF Sousa, MMF Souza; Santa Casa de Misericórdia de Assis—GN Betônico, AL Leonardi; Santa Casa de Caridade de Don Pedrito—J Alvarez, A Tarouco; Santa Casa de Misericórdia de Paraguaçu Paulista—JA Alves, PRG Silva; Santa Casa de Misericórdia de Porto Alegre—G Friedman, T Lisboa; Santa Casa de Misericórdia de Presidente Prudente—C Bosso, G Plantier; Santa Casa de Misericórdia de Ribeirão Preto—P Antoniazzi, F Ostini; Santa Casa de Misericórdia de Santana do Livramento—J Alvarez, D de Souza; Santa Casa de Misericórdia de Santo Amaro—P Chaves, J Farhat Junior; Santa Casa de Misericórdia de São Paulo—R Marco, E Peixoto; Santa Casa de Misericórdia de Vitória da Conquista—G Moreno; Santa Casa Maringá—Universidade Estadual Maringá —D Bolognese, P Torres; São Bernardo Apart Hospital—R López, M Rodrigues; Sociedade Beneficente de Senhoras Hospital Sírio-Libanês—LCP Azevedo, F Ramos; UNICAMP—UTI da Disciplina de Emergências Clínicas—C Gontijo-Coutinho, T Santos; Universidade Estadual de Londrina—C Grion, M Tanita; Vitória Apart Hospital—A Muniz, C Piras Canada (Country Coordinator: Lauralyn McIntyre): Hamilton Health Sciences, General Hospital Site—S Altayyar, A Fox-Robichaud, P Lysecki, E McDonald, E Rullo; Juravinski Hospital—T Karachi, S Oczkowski; Mount Sinai Hospital—M Christian, B Giacomino, M Jakab, S Shah; Nova Scotia Health Authority-Queen Elizabeth II Health Sciences Centre—R Hall, L Julien, M Kiberd; Ottawa Hospital, Civic Campus—B Gomes, H Langlois, L McIntyre; Ottawa Hospital, General Campus—H Langlois, L McIntyre, I Watpool; St. Boniface Hospital—R Arora, W Janz; St. Joseph Health Care—D Cook, B Rochwerg; Sunnybrook Health Sciences Centre—B Cuthbertson, N Marinoff, A Perez; University of Alberta—N Baig, S Bagshaw, K Reid; China (Country Coordinator: Youzhong An, Bin Du, and Jie Lv): Affiliated Hospital of Inner Mongolia Medical University—L Zhang; Beijing 301 Hospital ICU2 –F Zhou; Beijing Ditan Hospital—H Xiong; Beijing Fuxing Hospital—B Zhu; Beijing Hospital—Z Feng; Beijing People's Liberation Army 304 Hospital—Q Deng; Beijing Shijitan Hospital—S Niu; Beijing Shunyi Hospital—T Liu; Dalian Municipal Central Hospital—D Gong, H Zhou; Fifth Central Hospital of Tianjin—W Yang; First Affiliated Hospital of Guangxi Medical University—Y Pan, Y Zhou; First Affiliated Hospital of Guangzhou Medical University—X Liu; Foshan First People's Hospital—X Qiang; Fourth Hospital of Hebei Medical University—Y Hou, Z Hu; Fujian Provincial Hospital—X Shang, Y Zhang; Gejiu ‎People Hospital Yunnan; Guangdong General Hospital—S Wang; Hainan General Hospital—R Li; Navy General Hospital ICU1 –W Shuai; Navy General Hospital ICU2 –Y Liu; Peking Union Medical College Hospital—W Jiang, C Wang; Peking University Cancer Hospital—H Wang; Peking University First Hospital—T Yan; Peking University People's Hospital—J Lv; Peking University Shenzhen Hospital—H Luo; Shandong Provincial Hospital affiliated to Shandong University—C Wang, J Zhang; Shandong University Qilu Hospital—C Li; Shanghai Huashan Hospital North Hospital—J Cao; Sichuan Guanghan People's Hospital—L Deng; The People’s Hospital of Guangxi (EICU)—L Lu; Tianjin Second People's Hospital—J Liu; West China Hospital of Sichuan University—X Liao; Xiangya Hospital—C Zhao; Denmark (Country Coordinator: Peter B. Hjortrup): Aalborg University Hospital—B Rasmussen, Aarhus University Hospital—H Nibro; Copenhagen University Hospital, Neurointensive Care Unit—Y Mølgaard; Copenhagen University Hospital, Rigshospitalet—P Hjortrup, A Perner; Glostrup Hospital—A Bendtsen, H Hoffmeyer; Herlev Hospital—H Christensen; Herning Hospital—R Nielsen; Hjørring Hospital—P Langhoff; Holbæk Hospital—J Elkjær, N Seierby; Horsens Hospital—S Heintzelmann; Hillerød Hospital (Nordsjællands Hospital)—M Bestle, R Jørgensen; Randers Hospital—H Bundgaard; Slagelse Hospital—S Iversen; Vejle Hospital—P Berezowicz; France (Country Coordinator: Frederique Schortgen): Ambroise Paré Hospital—S Au, A Vieillard-Baron; ARCHET 1 University Hospital—J Dellamonica; Centre Hospitalier de Cannes—P Bertrand; Centre Hospitalier René DUBOS—Réanimation medico-chirurgicale—M Delattre, M Thuong; Centre Hospitalier Marc Jacquet—C Vinsonneau; CH de Chartres, Réanimation Polyvalente—A Conia; CHD Vendée—E Greau, J Lacherade; CHU d’Amiens—H Dupont, Y Mahjoub, E Zogheib; CHU Angers—M Masson, A Mercat, L Pierrot; CHU Charles Nicolle—P Guitard, B Veber; CHU Nantes—C Agasse, C Guitton; CHU Rouen, Medical ICU—G Béduneau, F Tamion; Cochin University Hospital—N Marin, J Mira; Grenoble University Hospital—C Schwebel; Groupe Hospitalier Pitié-Salpetrière—A Demoule, C Rolland-Debord; Gustave Roussy—L Berrahil-Meksen, F Blot; Henri Mondor Hospital—F Schortgen; Hôpital Privé Gériatrique Les Sources—J Fosse; Hôpital St Joseph, Réanimation Polyvalente—C Gregoire, B Misset; La Croix Rousse—C Guerin; Réanimation polyvalente CH Toulon, hôpital Ste Musse—J Durand-Gasselin, J Suppini; Réanimation médico-chirurgicale, CHU l’Archet 2 –P Danin; Réanimation Polyvalente CHRU Tours—S Ehrmann; Germany (Country Coordinator: Frank Bloos): Charité Berlin Campus Virchow—D Hasper; Diakoniekrankenhaus Friederikenstift gGmbH—F Honig; Herzzentrum Dresden—S Rasche; Jena University Hospital—F Bloos, K Reinhart; Kliniken Arnstadt-Ilmenau gGmbH/ Altenburg Hospital—H Schlegel-Höfner; Klinikum Augsburg—U Jaschinski, I Keruzer; Klinikum Emden—M Drüner, D Jarczak, K Kogelmann; Krankenhaus Düren gGmbH—J Schütte; Leopoldina Krankenhaus Schweinfurt GmbH—H Rensing; Maria Hilf Krankenhaus Mönchengladbach—H Haake; RoMed Klinikum Rosenheim—M Dunker; St. Elisabeth-Krankenhaus Köln-Hohenlind—F Fiedler; Universitätsklinikum Freiburg—S Utzolino; Universitätsklinikum Leipzig—J Wichmann; Universitätsmedizin Rostock—J Roesner; University Hospital Carl Gustav Carus, Tech. University of Dresden—M Ragaller, L Spielvogel; University Hospital Frankfurt—P Meybohm, K Zacharowski; University Hospital Tübingen—R Riessen; Zentralklinik Bad Berka—L Hüter; Greece: Hippocrateion General Hospital of Athens—M Hatzis, M Papanikolaou; India (Country Coordinator: A.P. Kulkarni): Convenient Hospitals Ltd CHL Hospitals—N Jain, M Pahuja; P.D Hinduja National Hospital—M Jariwala, F Kapadia; Sanjeevan Hospital—S Dixit, R Rhayakar; Siddharth Hospital and Research Center—S Agarwal, S Agarwal; Italy (Country Coordinator: Guido Bertolini): Az. Osp. Papa Giovanni XXIII—I Riva; Fondazione I.R.C.C.S. Policlinico San Matteo- Rianimazione I—I Bianchi, T Mediani; Fondazione I.R.C.C.S. Policlinico San Matteo, Rianimazione 2 —A Bottazzi, E Roldi; Ospedale civile di Vigevano—Azienda Ospedaliera di Pavia—L Carnevale, F Nicola; Ospedale del Mugello (Azienda Sanitaria Firenze)—M Morelli, V Parrini; Ospedale Luigi Sacco e Polo Universitario—R Colombo, T Fossali, Ospedale Maggiore di Crema—P Villani; Ospedale SS Cosma e Damiano di Pescia—A Ciani, L Rosso; Monaco (Country Coordinator: Frederique Schortgen): Centre Hospitalier Princesse Grace—L Bonnet, J Catineau, C Dugourd, J Guerin, N Rijo; Netherlands (Medical Center Leeuwarden (ICU)—M Kuiper, M Koopmans; New Zealand (Country Coordinator: Paul Young): Auckland City Hospital, Cardiothoracic & Vascular ICU—K Cowdrey, E Gilder, L McCarthy, S McGuinness, R Parke; Auckland City Hospital DCCM—C McArthur, L Newby; Christchurch Hospital—S Henderson, J Mehrtens; North Shore Hospital—D Hacking; Tauranga Hospital—T Browne, J Goodson; Waikato Hospital—R Frengley, M La Pine; Wellington Hospital—S Hurford, D Mackle, P Young; Norway (Country Coordinator: Lill-Kristin Kjærvik): Oslo University Hospital, Ullevål—LK Kjærvik; Oslo University Hospital, Rikshospitalet—LK Kjærvik; Republic of Korea: Samsung Medical Center—C Chung, K Jeon, C Park, J Park, G Suh, J Yang; Saudi Arabia (Country Coordinator: Yaseen Arabi): Alnoor Specialist Hospital—K Alkhatib, H Badr; King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center—Y Arabi, A Deeb; Scotland (Country Coordinator: Peter Andrews): Glasgow Royal Infirmary—A Puxty, T Quasim, Victorian Hospital—K Boath, M McDougall, C McGinn, A Wood, Western General Hospital—P Andrews, B Harris, Western Infirmary—S Henderson, M Sim; Singapore (Country Coordinator: Li Li): Alexandra Hospital—F Khan, C Tan; Changi General Hospital—N Lim; Khoo Tek Puat Hospital MICU—L Li, L Sennen; Khoo Tek Puat Hospital MICU—N Hock; National University Hospital MICU—V Ong, J Phua; National University Hospital SICU—T Addy; Tan Tock Seng Hospital (MICU)—B Heng, L Li; Tan Tock Seng Hospital (NICU)—L Hui, L Li, Y Wong; Tan Tock Seng Surgical ICU—L Li, T Reen, J Tan; Slovakia Region: University Hospital, Clinic of Anaesthesia and Intensive Care Medicine—A Dobisova; South Africa: Charlotte Maxeke Johannesburg Academic Hospital—I Kalla, H Redelinghuys, G Richards; King Edward VIII Hospital—K De Vasconcellos, D Skinner; Sweden (Country Coordinator: Niklas Nielsen): CIVA, Karolinska University Hospital, Solna—A Oldner, P Rudberg; Helsingborg Hospital—L Hassel, N Nielsen; ICU, NÄL—G Anderzon, B Lindqvist, P Petersen; Karolinska University Hospital, Huddinge—J Wernerman; Skane University Hospital, Lund—A Adolfsson, M Rundgren; Skaraborgs Sjukhus Skövde—J Wallén; United Kingdom: Belfast City Hospital—P Headley, J Silversides; Guys and St Thomas’ Hospital Trust—D Lux, T Sherry; Kent and Canterbury Hospital—R Kapoor; Pennine Acute Hospitals NHS Trust—K Naylor, C Veerappan; Queen Elizabeth the Queen Mother Hospital—R Kapoor; Royal United Hospital, Bath—J Nolan, J Penketh; University College London Hospital—M Mythen, S Patel; University Hospital of Wales—J Cole, N Palmer, M Wise; William Harvey Hospital—R Kapoor; United States of America: Albany Medical Center—L Duncan, N Robak; Baylor College of Medicine—E Calvillo, R Damani, P Gupta, N Maldonado, J Suarez, B Tan; Beth Israel Deaconess Medical Center—V Banner-Goodspeed, D Talmor; Massachusetts General Hospital & Harvard Medical School (MGH Surgical 1)—A Elsayes, E Fuentes, S Quraishi; Massachusetts General Hospital & Harvard Medical School (MGH Surgical 2)—A Elsayes, E Fuentes, S Quraishi; University Hospital, Surgical Trauma ICU—S Cohn, M DeRosa, R Jonas, K Rocchi; Vietnam: Cho Ray—P Huy, P Thao