PURPOSE: This study aims to assess the safety of nicotine replacement therapy (NRT) in a medical intensive care unit (MICU).
METHODS: We used pharmacy profiles in the MICU to identify patients who had been initiated on NRT. Matched controls were selected based on active tobacco use at the time of admission, predicted hospital mortality, and age. Primary endpoints included death and length of ICU and hospital stay.
RESULTS: Between February 2001 and February 2005, there were 6735 admissions to the MICU. Of these, NRT was initiated for 125 admissions. We excluded 7 cases due to incomplete medical charts and 6 cases due to lack of consent. Subsequently, 112 cases and 112 controls were included in the study. There were no statistically significant differences in age, gender, ethnicity and severity of illness measured by APACHE III prognostic model between the NRT and control groups. The median (interquartile range) (IQR) ICU length of stay for the NRT group was 24.4 (16.1 –63.6) hours compared to 22.6 (14.0 –42.8) hours for the control group (p value 0.1349). The median (IQR) hospital length of stay was 29.6 (18.3 –127.1) hours compared to 46.2 (19.8 –117.3) hours for the control group (p value 0.2992). Among the patients who received NRT, 18 deaths (16.1%) occurred compared to the 3 deaths (2.7%) in the control group (fisher’s exact p value 0.0009). The hospital mortality rate was 21.4% for the NRT group compared to 5.4% in the control group (p value 0.0004). Multiple logistic regression analysis including severity of illness in the model showed NRT was an independent risk factor for mortality with an odds ratio of 17.0 (95% confidence interval, 3.6 –79.0).
CONCLUSION: NRT may increase the risk of death in medical ICU patients.
CLINICAL IMPLICATIONS: NRT may not be safe to initiate in patients in the ICU.
DISCLOSURE: Amy Lee, None.