Tuesday July 24, 2007
Do we need nicotine replacement therapy in ICU ?


Putting nicotine patch in patients with smoking history is a common practice in ICUs. But do we really need it ?

It was a retrospective study of 90 patients (smokers with application of nicotine replacement treatment) compared with 90 control patients (smokers who did not receive nicotine replacement therapy). Patients were adjusted based on the severity of illness and then age.

Outcome was measured by

• hospital mortality and
• 28-day ICU day

Results:

• The observed hospital mortality rate was 20% in the cases vs. 7% in the control group ! (p = .0085).
  
• When adjusted for the severity of illness and invasive mechanical ventilation, nicotine replacement therapy was independently associated with increased mortality.
  

Discussion (taken from study): Activation of the sympathetic nervous system is the main mechanism by which nicotine leads to cardiovascular disease. The sympathomimetic effect of nicotine is independent of the level of nicotine exposure. The hemodynamic effects of nicotine include increased heart rate, blood pressure, and myocardial contractility. It also may cause constriction of coronary arteries. Although these hemodynamic effects have not been shown to be associated with poor outcome in healthy volunteers and those with stable coronary artery disease, they may be detrimental in critically ill patients. Its effect of increasing myocardial oxygen consumption during times of reduced oxygen delivery may lead to adverse outcome in critically ill patients.

Reference: click to get abstract

1. The association of nicotine replacement therapy with mortality in a medical intensive care unit. Critical Care Medicine. 35(6):1517-1521, June 2007.