title: Nicotine replacement therapy in critically ill patients: a prospective observational cohort study.
abstract: OBJECTIVE
  Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent nicotine withdrawal. However, recent studies have questioned the safety of this practice. The objective of this study was to determine the impact of nicotine replacement therapy on the outcomes of critically ill patients.
  
  
  METHODS
  Prospective observational cohort.
  
  
  METHODS
  The medical intensive care unit of a tertiary academic hospital.
  
  
  METHODS
  Active smokers admitted to the intensive care unit.
  
  
  METHODS
  None.
  
  
  RESULTS
  After excluding 2,411 patients who did not meet the study inclusion criteria, 330 were included in the study, of which 174 patients received and 156 did not receive nicotine replacement therapy. There were no significant differences in the unadjusted hospital mortality between the two groups: 14 patients (7.8%; 95% confidence interval, 4-12) died in the nicotine replacement therapy group as compared with ten patients (6.3%; 95% confidence interval, 2.6-10.3) in the nonnicotine replacement therapy group (p = .59). After adjusting for severity of illness and propensity score for administration of nicotine replacement therapy on intensive care unit admission, nicotine replacement therapy was not associated with increased hospital mortality (odds ratio, 1.4; 95% confidence interval, 0.5-3.9; p = .51).
  
  
  CONCLUSIONS
  Single-center observational study.
  
  
  CONCLUSIONS
  Nicotine replacement therapy is not associated with increased hospital mortality in critically ill patients. However, we were not able to demonstrate any clinically significant benefit from its use in the intensive care unit setting.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Cartin-Ceba
authors.forename: David O
authors.initials: DO
authors.lastname: Warner
authors.forename: J Taylor
authors.initials: JT
authors.lastname: Hays
authors.forename: Bekele
authors.initials: B
authors.lastname: Afessa
mesh_terms: D000328:Adult; D000368:Aged; D016638:Critical Illness; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009538:Nicotine / Q000008:administration & dosage* / Q000009:adverse effects*; D010146:Pain; D011446:Prospective Studies; D011595:Psychomotor Agitation; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000517:prevention & control*
chemical_list: D009538:Nicotine