Outcome of nicotine replacement therapy in patients admitted to ICU: a randomized controlled double-blind prospective pilot study

Abstract

Background: The effect of nicotine withdrawal in smokers admitted to the ICU is not well understood, so the role of nicotine replacement therapy (NRT) in those patients is controversial.

Objective: To determine whether NRT in ICU patients affects the need for sedatives/analgesics, ventilator days, and ICU stay.

Methods: In a 20-bed ICU, 40 subjects were randomized to either a 21 mg nicotine patch or a placebo nicotine patch daily until either ICU discharge, transfer to a medical floor, or 10 weeks in the ICU. We collected data on sedatives/analgesics use during ICU stay and use and duration of mechanical ventilation .

Results: There were 27 male and 13 female subjects. The mean age was 57.4 y in the intervention group and 52.5 y in the control group. The mean Acute Physiology and Chronic Health Evaluation II score was 14.3 in the intervention group and 13.8 in the control group. The mean ICU stay was 4.5 d in the intervention group and 7 d in the control group. The mean number of days on ventilator was 1.9 in the intervention group and 3.5 in the control group. The number of days on sedation/analgesia was less in the intervention group than in the control group.

Conclusions: Although ICU stay and ventilator days decreased numerically in this pilot study, statistically there was no beneficial effect from NRT. (International Standard Randomised Controlled Trial Register ISRCTN66928309).

Keywords: ICU; nicotine addiction; nicotine replacement therapy; smoking status.