1. Would you have allowed the collection of your medical information (such as vital signs or laboratory information) while you were in the Intensive Care Unit (ICU) and kept for a later study?
- All information would be kept confidential and would not be linked to your name or information.
	YES	NO
2. Would you have allowed the collection of a sample of your urine that would have otherwise been thrown away?
- There is no excess risk to the patient and samples would be taken from an indwelling catheter or voided sample.
	YES	NO
3. Would you have allowed the collection of 5 mL (approximately one tablespoon) of extra blood be taken from the existing venous catheter for a study at a later time?
– There is a (0.01%) risk of creating a line infection with this extra sample collection.
	YES	NO
4. Would you had been willing to have been transported to the radiology department and had a computed tomography scan (“CAT scan”) be performed for review at a later time?
- There are potential risks of having catheters and tubes becoming dislodged during the move to radiology (< 1%) and unknown risks involved in the minimal radiation exposure from the scan.
	YES	NO
5. Would you have allowed a small muscle biopsy (the size of a pea) with local anesthetic to have been performed while you were under heavy sedation for review at a later time?
-The risks for this procedure include a 25% chance of mild pain at the site and a 0.5% chance of minor infection.
	YES	NO
6. Would you have allowed a bronchoalveolar lavage to have been performed while you had already had tube down your throat and were under heavy sedation, and have the results stored for study at a later time. This procedure involves have a flexible tube passed inside of the existing tube that was already in your throat. The flexible tube would be passed down into your lungs and a small amount of fluid (50 mls) would be placed into the lungs and then quickly suctioned back out. This procedure is often routinely performed to help identify infections in the lung?
- The risks for this procedure include: 0.5% chance of minor complication such as a temporary lower blood oxygen levels or lower blood pressure. There is a 25% chance of short term fever.
- The procedure has a <1% chance of detecting some other treatable illness
	YES	NO
7. Would you have allowed your participation in a clinical trial where one half of the patients are given a placebo (normal glucose) and the other half are given a dose of antacid for treatment of stress gastritis, which is a complication of serious illness?
- There is a 1% chance of getting stress gastritis by getting the sugar dose.
- There is a 50% chance of getting the antacid and side effects include: abdominal pain (1.8%), diarrhea (8%), and nausea (3.7%). There is a <0.1% risk of hip fracture with use greater than 6 months.
	YES	NO