Nicotine replacement may hurt ICU patients

Mayo Clinics researchers say smokers admitted to intensive care units appear to be at higher risk of cardiovascular events and death if they are given nicotine replacement therapy to ameliorate acute nicotine withdrawal. The researchers presented their findings at the annual meeting of the American College of Chest Physicians.

Amy Lee, MD, and Bekela Afessa, MD, conducted a retrospective study of 224 heavy smokers admitted to the ICU; half received nicotine replacement therapy and half did not. Severity of illness was reported to be similar in the two groups, which also were matched for age, gender, and ethnicity. Median length of stay in the ICU and the hospital stay overall was not significantly different between the groups.

Although nicotine replacement therapy is not standard practice for ICU patients, some units have nurse-driven protocols for doing so, according to presentation materials.

There were 18 deaths (16.1%) in the nicotine replacement therapy group, compared with three deaths (2.7%) in the control group. The researchers noted that hemodynamic effects of nicotine withdrawal, including increased blood pressure, heart rate, and coronary artery constriction, can theoretically complicate management of a critically ill patient. Previous studies have shown that nicotine replacement therapy is safe for general medical patients.

"Our study showed that nicotine replacement therapy may not be safe in critically ill patients," the researchers told Reuters. "But this does not include general medical patients in the hospital or outpatients. However, even for the critically ill patient, we cannot confidently say it does harm because our study was retrospective with several limitations."