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The association of nicotine replacement therapy with mortality in a medical intensive care unit.
Crit Care Med. 2007 Jun; 35(6):1517-21.CC

Abstract

OBJECTIVE

Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent withdrawal. However, the safety of nicotine replacement in the critically ill has not been studied. The objective of this study was to determine the impact of nicotine replacement on the outcome of critically ill patients.

DESIGN

Retrospective, case-control.

SETTING

The medical intensive care unit of a tertiary academic hospital.

PATIENTS

Patients who were active smokers at admission to the intensive care unit were included in the study. Those who received nicotine replacement therapy were considered as cases, and those who did not receive nicotine replacement were considered as controls.

INTERVENTIONS

None.

MEASUREMENTS AND MAIN RESULTS

For each of the 90 cases, one control smoker who did not receive nicotine replacement therapy was selected based on the severity of illness and then age. Outcome was measured by hospital mortality and 28-day intensive care unit-free days, defined as the number of days spent outside of intensive care or without mechanical ventilation by a living patient following admission to intensive care. The mean mortality rate predicted by the Acute Physiology and Chronic Health Evaluation III was 9.2% for the cases compared with 10.3% for the controls (p = .7127). The observed hospital mortality rate was 20% in the cases vs. 7% in the control group (p = .0085). When adjusted for the severity of illness and invasive mechanical ventilation, nicotine replacement therapy was independently associated with increased mortality (odds ratio, 24.6; 95% confidence interval, 3.6-167.6; p = .0011). The mean (sd) 28-day intensive care unit-free days were 20.7 (10.5) in the case group compared with 23.4 (7.1) in the control group (p = .0488).

CONCLUSIONS

Our study shows that nicotine replacement therapy is associated with increased hospital mortality in critically ill patients. However, because of the limitations of the study, a future study based on a better case-control design is warranted.

Authors+Show Affiliations

Division of Pulmonary and Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, USA.No affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17452926

Citation

Lee, Amy H., and Bekele Afessa. "The Association of Nicotine Replacement Therapy With Mortality in a Medical Intensive Care Unit." Critical Care Medicine, vol. 35, no. 6, 2007, pp. 1517-21.
Lee AH, Afessa B. The association of nicotine replacement therapy with mortality in a medical intensive care unit. Crit Care Med. 2007;35(6):1517-21.
Lee, A. H., & Afessa, B. (2007). The association of nicotine replacement therapy with mortality in a medical intensive care unit. Critical Care Medicine, 35(6), 1517-21.
Lee AH, Afessa B. The Association of Nicotine Replacement Therapy With Mortality in a Medical Intensive Care Unit. Crit Care Med. 2007;35(6):1517-21. PubMed PMID: 17452926.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The association of nicotine replacement therapy with mortality in a medical intensive care unit. AU - Lee,Amy H, AU - Afessa,Bekele, PY - 2007/4/25/pubmed PY - 2007/7/3/medline PY - 2007/4/25/entrez SP - 1517 EP - 21 JF - Critical care medicine JO - Crit Care Med VL - 35 IS - 6 N2 - OBJECTIVE: Smokers admitted to the intensive care unit may receive nicotine replacement therapy to prevent withdrawal. However, the safety of nicotine replacement in the critically ill has not been studied. The objective of this study was to determine the impact of nicotine replacement on the outcome of critically ill patients. DESIGN: Retrospective, case-control. SETTING: The medical intensive care unit of a tertiary academic hospital. PATIENTS: Patients who were active smokers at admission to the intensive care unit were included in the study. Those who received nicotine replacement therapy were considered as cases, and those who did not receive nicotine replacement were considered as controls. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For each of the 90 cases, one control smoker who did not receive nicotine replacement therapy was selected based on the severity of illness and then age. Outcome was measured by hospital mortality and 28-day intensive care unit-free days, defined as the number of days spent outside of intensive care or without mechanical ventilation by a living patient following admission to intensive care. The mean mortality rate predicted by the Acute Physiology and Chronic Health Evaluation III was 9.2% for the cases compared with 10.3% for the controls (p = .7127). The observed hospital mortality rate was 20% in the cases vs. 7% in the control group (p = .0085). When adjusted for the severity of illness and invasive mechanical ventilation, nicotine replacement therapy was independently associated with increased mortality (odds ratio, 24.6; 95% confidence interval, 3.6-167.6; p = .0011). The mean (sd) 28-day intensive care unit-free days were 20.7 (10.5) in the case group compared with 23.4 (7.1) in the control group (p = .0488). CONCLUSIONS: Our study shows that nicotine replacement therapy is associated with increased hospital mortality in critically ill patients. However, because of the limitations of the study, a future study based on a better case-control design is warranted. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/17452926/The_association_of_nicotine_replacement_therapy_with_mortality_in_a_medical_intensive_care_unit_ L2 - https://dx.doi.org/10.1097/01.CCM.0000266537.86437.38 DB - PRIME DP - Unbound Medicine ER -