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Nicotine replacement therapy in critically ill patients: A prospective observational cohort study*

Cartin-Ceba, Rodrigo MD; Warner, David O. MD; Hays, J. Taylor MD; Afessa, Bekele MD

doi: 10.1097/CCM.0b013e31821867b8
Clinical Investigations

Objective: Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent nicotine withdrawal. However, recent studies have questioned the safety of this practice. The objective of this study was to determine the impact of nicotine replacement therapy on the outcomes of critically ill patients.

Design: Prospective observational cohort.

Setting: The medical intensive care unit of a tertiary academic hospital.

Patients: Active smokers admitted to the intensive care unit.

Interventions: None.

Measurements and Main Results: After excluding 2,411 patients who did not meet the study inclusion criteria, 330 were included in the study, of which 174 patients received and 156 did not receive nicotine replacement therapy. There were no significant differences in the unadjusted hospital mortality between the two groups: 14 patients (7.8%; 95% confidence interval, 4–12) died in the nicotine replacement therapy group as compared with ten patients (6.3%; 95% confidence interval, 2.6–10.3) in the nonnicotine replacement therapy group (p = .59). After adjusting for severity of illness and propensity score for administration of nicotine replacement therapy on intensive care unit admission, nicotine replacement therapy was not associated with increased hospital mortality (odds ratio, 1.4; 95% confidence interval, 0.5–3.9; p = .51).

Limitations: Single-center observational study.

Conclusions: Nicotine replacement therapy is not associated with increased hospital mortality in critically ill patients. However, we were not able to demonstrate any clinically significant benefit from its use in the intensive care unit setting.

From the Division of Pulmonary and Critical Care Medicine (RC-C, BA) and the Division of General Internal Medicine (JTH), Department of Internal Medicine, Multidisciplinary Epidemiology and Translational Research in Intensive Care (METRIC) (RC-C), the Department of Anesthesiology (DOW), and the Nicotine Dependance Center (JTH), Mayo Clinic, Rochester, MN.

The authors have not disclosed any potential conflicts of interest.

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© 2011 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins