Supplemental material for The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit

<p>Supplemental material for The influence of alcohol abuse on agitation, delirium and sedative requirements of patients admitted to a general intensive care unit by Donald Stewart, John Kinsella, Joanne McPeake, Tara Quasim and Alex Puxty in Journal of the Intensive Care Society</p

Figure 1

<p><b>1a</b>. The relationship between CRP (log 10) and 25 (OH) D in the nutritional screen cohort (<i>r_s</i> = −0.113, p<0.001). <b>1b</b>. The relationship between albumin and 25 (OH) D in the nutritional screen cohort (<i>r_s</i> = 0.192, p<0.001). <b>1c</b>. The relationship between CRP (log 10) and 25 (OH) D adjusted to albumin in the nutritional screen cohort (<i>r_s</i> = −0.053, p<0.001). <b>1d</b>. The relationship between albumin and 25 (OH) D adjusted to CRP in the nutritional screen cohort (<i>r_s</i> = 0.507, p<0.001).</p

Figure 2

<p><b>2a</b>. The relationship between CRP (log 10) and 25 (OH) D in patients with critical illness (<i>r_s</i> = −0.221, p = 0.017). <b>2b</b>. The relationship between albumin and 25 (OH) D in patients with critical illness (<i>r_s</i> = 0.166, p = 0.073). <b>2c</b>. The relationship between CRP (log 10) and 25 (OH) D adjusted to albumin in patients with critical illness (<i>r_s</i> = 0.016, p = 0.863). <b>2d</b>. The relationship between albumin and 25 (OH) D adjusted to CRP in patients with critical illness (<i>r_s</i> = 0.363, p<0.001).</p

Distribution in percentiles of plasma 25 (OH) D according to CRP and albumin concentrations (n = 5327).

a<p>Kruskal Wallis,</p>b<p>Mann-Whitney <i>U</i> test. When n<5 median value was not calculated.</p

Rate of occult neck nodal metastasis in primary and salvage laryngectomy

The role of neck dissection (ND) in advanced laryngeal cancer remains controversial. Cervical nodal metastases confer a worse prognosis with higher rates of local recurrence and reduced overall survival observed in this population. Elective ND for clinically node negative (N0) patients during laryngectomy has been associated with reduced rates of regional recurrence; however, the addition of this surgical intervention introduces risk of complications including accessory nerve injury, wound healing issues and infection. Select European society guidelines, such as the German guidelines for treatment of laryngeal cancer, recommend ipsilateral ND for lateralised laryngeal malignancy and bilateral ND for midline lesions, while guidelines in the United Kingdom and the National Comprehensive Cancer Network (NCCN) in the United States offer more broad recommendations encompassing numerous surgical options. In salvage laryngectomy, the role of N0 elective ND remains equally ambiguous. The overall rate of occult metastasis following salvage laryngectomy with ND has been reported as 3%–19%. Many studies pre-date the development of advanced radiological investigations and therapeutic techniques. Recent attempts at meta-analysis found only three papers suitable for inclusion in pooled analysis.</p

Additional file 1: Table S1. of Early troponin I in critical illness and its association with hospital mortality: a cohort study

Baseline characteristics. Table S2. Baseline characteristics for patients eligible for routine TnI within 24 h of ICU admission. Table S3. Baseline characteristics: London dataset. Table S4. Coefficients and SE for whole dataset. Figure S1. Calibration plot for predicted vs actual probabilityof hospital mortality. Figure S2. Association of troponin I (in mg/L) with hospital mortality with interaction term for sex. (DOCX 93 kb

Intensive Care Syndrome: Promoting Independence and Return to Employment (InS:PIRE). Early evaluation of a complex intervention

<div><p>Background</p><p>Many patients suffer significant physical, social and psychological problems in the months and years following critical care discharge. At present, there is minimal evidence of any effective interventions to support this patient group following hospital discharge. The aim of this project was to understand the impact of a complex intervention for ICU survivors.</p><p>Methods</p><p>Quality improvement project conducted between September 2014 and June 2016, enrolling 49 selected patients from one ICU in Scotland. To evaluate the impact of this programme outcomes were compared to an existing cohort of patients from the same ICU from 2008–2009. Patients attended a five week peer supported rehabilitation programme. This multidisciplinary programme included pharmacy, physiotherapy, nursing, medical, and psychology input. The primary outcome in this evaluation was the EQ-5D, a validated measure of health-related quality of life. The minimally clinically important difference (MCID) in the EQ-5D is 0.08. We also measured change in self-efficacy over the programme duration. Based on previous research, this study utilised a 2.4 (6%) point change in self-efficacy scores as a MCID.</p><p>Results</p><p>40 patients (82%) completed follow-up surveys at 12 months. After regression adjustment for those factors known to impact recovery from critical care, there was a 0.07–0.16 point improvement in quality of life for those patients who took part in the intervention compared to historical controls from the same institution, depending on specific regression strategy used. Self-efficacy scores increased by 2.5 points (6.25%) over the duration of the five week programme (p = 0.003), and was sustained at one year post intervention. In the year following ICU, 15 InS:PIRE patients returned to employment or volunteering roles (88%) compared with 11 (46%) in the historical control group (p = 0.15).</p><p>Conclusions and relevance</p><p>This historical control study suggests that a complex intervention may improve quality of life and self-efficacy in survivors of ICU. A larger, multi-centre study is needed to investigate this intervention further.</p></div

Patient flow through the InS:PIRE programme.

<p>Patient flow through the InS:PIRE programme.</p

Themes and sub themes generated from the qualitative interviews.

<p>Themes and sub themes generated from the qualitative interviews.</p

InS:PIRE conceptual framework.

<p>InS:PIRE conceptual framework.</p