Nicotine replacement therapy is associated with improved outcomes in critically ill smokers

Introduction

Recently published literature suggests that the use of nicotine replacement therapy in critically ill smokers may lead to increased mortality in the ICU [1]. The objective of this study was to test this hypothesis retrospectively in a single, combined medical and surgical ICU in a community-based academic hospital.

Methods

We retrospectively reviewed all of the admissions to our ICU in the period 1 July 2006 and 30 June 2007. Our ICU is a 16-bed, combined medical and surgical ICU at a community-based academic hospital with a critical care medicine fellowship. Critically ill, active cigarette smokers were identified as our study group, and demographic information, the use of nicotine replacement, ICU length of stay, and ICU mortality were collected and analyzed.

Results

We reviewed 874 charts, 420 females (48.1%) and 454 males (51.9%); there were 688 nonsmokers (78.7%) and 186 (21.3%) smokers. There was a statistically significant reduction in mortality in the nicotine replacement group compared with smokers who did not receive nicotine replacement. (10.1% vs 23.7%, P < 0.05). The ICU length of stay was longer in the smokers versus nonsmokers overall, although not statistically significant (156.4 hours vs 109.2 hours, P > 0.1). The length of stay was longer in the smokers who received nicotine replacement versus those who did not receive it. (315.4 hours vs 273.0 hours, P < 0.003).

Conclusion

While there was a trend to worse outcome in critically ill smokers versus nonsmokers, this was not found to be statistically significant. In the main study group of smokers, nicotine replacement was clearly associated with decreased mortality. The increased length of stay found in smokers receiving nicotine replacement therapy may have been directly attributable to their decreased mortality. This finding is in direct contrast with a recently published study of similar size and suggests that there is a role for a prospective study to determine the appropriate management with regard to nicotine replacement therapy in critically ill patients.