Ng KT, et al. - Nicotine replacement therapy was appraised as a management strategy for nicotine withdrawal in critically ill smokers admitted to intensive care unit (ICU), focusing mainly on its impact on delirium, mortality or length of stay. Absence of high-quality data did not allow to make current recommendation for a routine use of nicotine replacement therapy to prevent delirium or to reduce hospital or ICU mortality in critically ill smokers.

Methods

• The primary outcome was incidence of author-defined ICU delirium and secondary outcomes were ICU or hospital mortality, ICU-free days at day 28, and ICU or hospital length of stay.
• Researchers performed a systematic review and meta-analysis of the data sources MEDLINE, EMBASE, CINAHL, and the Cochrane Database of Systematic Reviews for randomised controlled trials and observational studies.
• They included clinical trials, observational studies and systematic reviews comparing nicotine replacement therapy with placebo or no treatment and excluded case reports, case series, non-systematic reviews and studies that involved children.

Results

• Eight studies were eligible (n=2,636) for inclusion in the data synthesis.
• A meta-analysis of observational studies reported an association of nicotine replacement therapy with increased delirium (three studies; n=908; I²=0%; finite element method: odds ratio 4.03 [95% confidence interval 2.64, 6.15]; P <0.001).
• Researchers found no difference in ICU mortality (three studies; n=1,309; P=0.10, I²=44%; finite element method: odds ratio 0.58; 95% confidence intervals 0.31–1.10) and hospital mortality or 28-day ICU-free days.