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Namibia
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MV Patient Registry

If the patient was treated with invasive mechanical ventilation (MV) during his/her hospital stay, please fill out the MV Patient Registry form below.

Health care facility

Name of hospital

Rundu State Hospital

Onandjokwe State Hospital

Patient identification

First name

Family name

Sex

male

female

Date of birth

Europe/Berlin

Estimated gestational age at birth (weeks)

Birth weight (grams)

Diagnoses

Main diagnosis I

Main diagnosis II

Main diagnosis III

Chest X-ray obtained

yes

no

If yes, main findings (please, be specific)

Respiratory therapies

Surfactant given

yes

no

Date when put on invasive MV

Europe/Berlin

Date when invasive MV was stopped

Europe/Berlin

Days on invasive MV

Complications while on invasive MV (describe in detail)

Initial respiratory support after extubation

CPAP

Nasal cannula oxygen

No respiratory support

Outcome

Please, select final outcome at discharge

Survived

Died

If patient died, date of death

Europe/Berlin

If patient died, main causes of death (please, describe in detail)

Additional comments

Please, describe in detail

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