Nicotine replacement may be unsafe in ICU patients

By Martha Kerr

SALT LAKE CITY (Reuters Health) - Smokers admitted to intensive care units (ICU) appear to have a higher risk of having a cardiovascular event or dying if they receive nicotine replacement therapy to prevent acute nicotine withdrawal, according to findings presented at CHEST 2006, the annual meeting of the American College of Chest Physicians.

The researchers noted that hemodynamic effects of nicotine withdrawal, including increased blood pressure, heart rate and coronary artery constriction, can theoretically complicate the treatment of a critically ill patient. Furthermore, previous studies have shown that nicotine replacement therapy is safe for the general medical patient.

Nicotine replacement is not standard practice for ICU patients, but some units have "nurse-driven protocols" for doing so, according to background materials related to the presentation.

Drs. Amy Lee and Bekela Afessa of the Mayo Clinic College of Medicine in Minneapolis, Minnesota, conducted a review study of 224 heavy smokers admitted to the ICU -- half of the patients received nicotine replacement therapy and the other half did not (the "control" group).

Severity of illness was similar in the two groups, who were also matched for age, sex and ethnic background. The average length of stay in the ICU and the hospital stay overall was not significantly different between the groups.

There were 18 deaths (16.1 percent) in the nicotine replacement therapy group compared with 3 deaths (2.7 percent) in the control group. After accounting for multiple risk factors that could influence the study findings, the researchers found that nicotine replacement therapy was an independent risk factor for dying.

"Our study showed that nicotine replacement therapy may not be safe in critically ill patients, but this does not include general medical patients in the hospital or outpatients," Afessa emphasized in comments to Reuters Health. "However, even for the critically ill patient, we cannot confidently say it does harm" because of the design and the several limitations of this study.