Critical care support of patients with nicotine addiction

Abstract

Over 500 million of the current world population will die from diseases caused by smoking cigarettes. The symptoms and signs of nicotine withdrawal are not well described in the critically ill. Since the various conditions of critical illness may lead to clinical manifestations mimicking nicotine withdrawal, describing its specific manifestations may not be easy. A few case reports suggest that nicotine replacement therapy may ameliorate nicotine withdrawal in the critically ill. However, retrospective studies have found that it may increase mortality. Despite the abundance of active smokers, there is a paucity of data describing nicotine withdrawal, and its prevention and treatment options in the critically ill. Future studies are warranted to address these issues.

Nicotine Replacement Therapy After Subarachnoid Hemorrhage Is Not Associated With Increased Vasospasm

“…23 The literature is extremely limited but most recent studies in the intensive care unit population report no increase in mortality in the medical intensive care unit and neuroscience intensive care units, 24,25 although patients undergoing cardiac surgery did have NRT-associated increases in postoperative mortality and some authors warn that NRT is not harmless and that the further prospective study is necessary. 26 A recent study 25 in patients with SAH even found a mortality benefit at 3 months with NRT.…”

Nicotine replacement therapy for agitation and delirium management in the intensive care unit: a systematic review of the literature

“…NRT primarily acts to reduce the severity of the urge to smoke and other withdrawal symptoms. It is unclear how critically ill patients are affected by these symptoms; hence, there is uncertainty about the benefits of using NRT [11]. A recent systematic review concluded that NRT should only be considered in selected ICU patients, due to a lack of evidence regarding efficacy and safety; however, the primary endpoint of interest was mortality [12].…”

Dose-related effect of smoking on mortality in critically ill patients: a multicentre cohort study

“…It has been estimated that over 500 million people will die from diseases caused by smoking cigarettes [1]. The effects of smoking on chronic diseases have been the main focus for public health prevention for many years [2], whilst its adverse effects on acute health conditions have only recently received more attention.…”