Outcome of nicotine replacement therapy in patients admitted to intensive care unit: A randomized case-control double blinded prospective pilot study

Introduction: The effects of nicotine withdrawal in smokers admitted to ICUs are not well understood and therefore the role of Nicotine Replacement Therapy (NRT) in patients admitted to ICUs is controversial. Aims: To prove that NRT in ICU patients decreases the use of sedatives and analgesics, the number of days on ventilator, and the total ICU stay. Methods: The study was performed in the 20 bed ICU. Forty patients meeting inclusion and exclusion criteria were randomized into either an interventional or control group. Patients in the interventional group received a 21mg nicotine patch every day until the patient was discharged from the ICU, transferred to the general medical floor, or until 10 weeks. Patients in the control arm received fake patch.The use of sedatives and analgesics during ICU stay, and use and duration of invasive mechanical ventilator were noted. The length of ICU stay was also compared in both the groups. Results: Twenty-seven patients were male,13 were female. The mean age of the interventional group patients was 57.4 years and 52.5 years in the control group.The mean APACHE II score was 14.3 in the interventional group vs. 13.8 in the control group.The mean length of ICU stay in the interventional group was 4.5 days while in the control group mean length of ICU stay was 7 days. The mean number of days on ventilator in interventional group was 1.9 days vs. 3.5 days in the control group. The number of days on sedation and analgesia was also less in the interventional group compared to the control group. Conclusion: The length of ICU stay and the number of days on ventilator decreases in the patients receiving NRT.