Delirium from nicotine withdrawal in neuro-ICU patients

Mayer, S. A.; Chong, Ji Y.; Ridgway, Emily B.; Min, Kan; Commichau, Christopher; Bernardini, G.

doi:10.1212/wnl.57.3.551

Cited by 66 publications

(57 citation statements)

References 11 publications

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“…As a first step to help patients quit smoking, we routinely treat all smokers with a transdermal nicotine patch in the hospital and after discharge, which may provide the added benefit of preventing delirium secondary to nicotine withdrawal during the acute phase of the illness. 41 Simply informing early-onset smokers (Յ16 years of age) that they are at increased risk for continued cigarette use may help raise awareness of this issue and encourage family support. There is a need to develop improved psychosocial and medical treatment interventions targeted at smoking cessation after SAH, which should be routinely offered as part of the rehabilitation and ongoing care of these patients.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors for Continued Cigarette Use After Subarachnoid Hemorrhage

Ballard

Kreiter

Claassen

et al. 2003

Stroke

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Background and Purpose-Cigarette smoking is a risk factor for the formation and rupture of intracranial aneurysms. Few studies have examined predictors of resumption of cigarette smoking after a first episode of subarachnoid hemorrhage (SAH). Methods-Of 620 SAH patients treated between July 1996 and November 2002, we prospectively evaluated continued cigarette use in 152 smokers alive at 3 months. Univariate and multivariate logistic regression analyses were used to identify potential demographic, social, and clinical predictors of continued cigarette use, defined as smoking Ն1 cigarette per week in the month before follow-up. Results-Thirty-seven percent (56 of 152) resumed smoking after their SAH. Patients who continued smoking were younger, were more often black, had begun smoking at an earlier age, and had a higher frequency of prior alcohol or cocaine use and self-reported depression or anxiety than those who quit (all PϽ0.05 Key Words: alcohol drinking Ⅲ cerebral aneurysm Ⅲ cigarette smoking Ⅲ subarachnoid hemorrhage S ubarachnoid hemorrhage (SAH) affects Ϸ21 000 adults in North America each year. 1 Even with significant improvements in the medical and surgical management of SAH, case fatality rates remain between 30% and 50%, 2-5 and those who survive frequently report impaired quality of life (QOL) characterized by disruptive cognitive and emotional symptoms. 3 A recurrent episode of SAH occurs in Ϸ2% to 3% of patients each year after surgical or endovascular aneurysm repair, and this risk increases with time. 6,7 Cigarette smoking is an important modifiable risk factor for SAH. 2,8 -12 Tobacco use is also a risk factor for the formation of multiple 13 and larger 14 aneurysms and therefore may be a risk factor for recurrent SAH after aneurysm repair. 8 Although it is known that up to 60% to 70% of SAH patients smoke cigarettes, 12,13 few studies have examined how many of these patients resume smoking after their hemorrhage or why they return. One study found that the proportion of smokers decreased from 58% before SAH to 30% 4 to 7 years later. 15 To the best of our knowledge, no studies have specifically analyzed risk factors for smoking resumption after SAH.Identification of risk factors for continued cigarette use after SAH may allow more effective substance use interventions while patients are in the hospital and may ultimately decrease the risk of recurrent SAH and other cardiovascular events. For instance, multidisciplinary hospital-based intervention programs increase the frequency of smoking cessation after myocardial infarction, 16,17 which results in reduced long-term mortality. 18 In this study, we sought to determine the frequency of continued cigarette use 3 months after SAH and to identify risk factors for smoking resumption. Patients and Methods Patient Population and Baseline AssessmentSix hundred twenty-six SAH patients admitted consecutively to our Neurological Intensive Care Unit (NICU) between July 1996 and November 2002 were prospectively enrolled in the Columbia University SAH Outc...

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Section: Discussionmentioning

confidence: 99%

Risk Factors for Continued Cigarette Use After Subarachnoid Hemorrhage

Ballard

Kreiter

Claassen

et al. 2003

Stroke

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“…Also, peak withdrawal symptoms can coincide with the occurrence of early cerebral vasospasm. Despite a good proportion of smokers among admitted patients and the concern for delirium as described in case reports, 5 the true impact of nicotine withdrawal in the critically ill population is not well described or characterized and thus the current practice of nicotine replacement therapy is not uniform.…”

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confidence: 99%

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

Carandang

Barton²,

Rordorf³

et al. 2011

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Background and Purpose-A significant number of patients with aneurysmal subarachnoid hemorrhage are active smokers and at risk for acute nicotine withdrawal. There is conflicting literature regarding the vascular effects of nicotine and theoretical concern that it may worsen vasospasm. The literature on the safety of nicotine replacement therapy and its effects on vasospasm is limited. Methods-A retrospective analysis was conducted of a prospectively collected database of aneurysmal subarachnoid hemorrhage patients admitted to the neurointensive care unit from 1994 to 2008. Paired control subjects matched for age, sex, Fisher score, aneurysm size and number, hypertension, and current medication were analyzed. The primary outcome was clinical and angiographic vasospasm and the secondary outcome was Glasgow Outcome Score on discharge.Conditional logistic models were used to investigate univariate and multivariate relationships between predictors and outcome. Results-Two hundred fifty-eight active smoking patients were included of which 87 were treated with transdermal nicotine replacement therapy.

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“…Nicotine is a cognitive enhancer in normal subjects and a possible treatment against the cognitive defects observed in a variety of mental disorders such as schizophrenia, Alzheimer's disease and attention deficit/hyperactivity disorder (see Levin and Simon 1998 for a review). Moreover, it was recently evidenced that nicotine might be involved in the development and reduction of psychotic symptoms in inpatients (Krajnik and Zylicz 1995;Gallagher 1998;Mayer et al 2001). We observed here that the two mAChRs agonists, oxotremorine and pilocarpine, had no relevant effect in reversing the abnormal processing previously induced by a cholinergic pharmacological alteration (atropine) in rats, whereas xanomeline and nicotine had a clear beneficial effect.…”

Section: Discussionmentioning

confidence: 51%