Nicotine patches may
boost intensive care risk

• 19:30 25 October 2006
• NewScientist.com news service
• Roxanne Khamsi

Nicotine given to intensive care patients to ease their withdrawal from cigarettes may put them at a greater risk of death than going "cold turkey", researchers say.

A preliminary study of more than 200 smokers placed in intensive care suggests they are better off simply enduring withdrawal symptoms than receiving nicotine replacement therapy (NRT).

Nicotine replacement therapy has become common in hospitals�?intensive care units (ICUs) in the last five to 10 years. The drug reduces withdrawal symptoms, such as headache and irritability, among smokers in these units, who are too sick to go to an area where they can smoke.

Bekele Afessa at the Mayo Clinic College of Medicine in Rochester, Minnesota, US, and colleagues expected to find that patients comforted by (NRT) fare better than smokers who do not receive it.

Heart power

The team examined the intensive care records of 224 smokers, half of which received NRT, mostly via skin patches.

Surprisingly, they found that 18 of the patients on NRT died, compared with just three of the smokers that did not receive nicotine. Also, the average duration of an ICU stay for patients given nicotine was 24.4 hours, about 2 hours longer than their cold-turkey counterparts.

“We have to be aware that we may be doing some harm [by giving patients NRT]," Afessa warns.

He notes that many of the patients in the study had been admitted to the ICU because they had gone into sepsis due to an infection. Sepsis can cause the body to release myocardial depressant factor, a molecule that reduces the pumping power of the heart.

Nicotine may further weaken the hearts of these patients by causing the coronary artery feeding the heart, to narrow, he suggests. This would reduce the amount of oxygen being pumped to other organs in the body. Many of the ICU patients in the trial died of multiple organ failure.

Wake-up call

Nicotine is known to cause a narrowing of the coronary artery in chronic smokers, but remains unknown whether short-term doses of the drug can have the same effect.

Experts say the results of the new study should encourage more research on how NRT affects hospital patients. “This is a wake-up call that we really need to study this,�?says Mark Rosen, president of the American College of Chest Physicians.

He adds, however, that a large prospective study is necessary to establish whether nicotine definitely causes an increased risk of death among patients.

Afessa presented the findings at the annual meeting of the American College of Chest Physicians (ACCP) in Salt Lake City, Utah, US, on Wednesday.

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