Nicotine Replacement May Be Deadly for ICU Patients

Smokers admitted to the intensive care unit (ICU) who receive nicotine replacement therapy during their hospitalization had a higher risk of death compared to smokers in the same conditions who did not receive nicotine replacement therapy (NRT).

These findings were presented by the American College of Chest Physicians (ACCP) at their recent annual international scientific meeting.

For some critically ill patients, nicotine withdrawal can worsen their prognosis; therefore, NRT is often given to active smokers in the ICU to prevent nicotine withdrawal symptoms.

Nicotine is known to increase heart rate, to increase body-wide arterial blood pressure, and to lead to constriction of the coronary arteries. These effects do not seem to worsen the outcome for healthy volunteers or those with stable coronary artery disease, but are harmful to critically ill patients.

In this study, the records of 112 patients were reviewed. After controlling for factors like age, ethnicity, gender, and severity of illness, patients who had been given NRT in the ICU were about 6x more likely to die compared to those who did not receive NRT.

This is a complex issue, because nicotine withdrawal symptoms may lead to problems with patient management, but treating the nicotine withdrawal symptoms using NRT may have even worse outcomes. The search continues for a new solution to manage this life and death issue.