Nicotine Withdrawal Syndrome in Intensive Care Patients-Preventive and Therapeutic Implications

Nicotine dependence is a chronic disorder with both psychological and somatic components which, in the intensive care unit (ICU) setting, may affect the course of treatment through mechanisms related both to long-term nicotine exposure and to the consequences of its abrupt cessation. The aim was to collect and map the current knowledge on smoking-related complications, the prevalence of nicotine withdrawal symptoms in this group, and to identify and describe interventions used to prevent or alleviate nicotine withdrawal symptoms in patients hospitalised in the ICU.

The review included sources retrieved from databases such as PubMed, CINAHL, Scopus, Web of Science, and the Cochrane Library, published in English, that met the PCC criteria, with no time restrictions.

Forty-four sources were included. Twenty-nine contributed evidence on smoking-related status as an exposure or associated factor, five explicitly focused on abrupt nicotine cessation or nicotine withdrawal syndrome, and fifteen addressed interventions; categories overlapped. Delirium was the most frequently investigated outcome in smoking-related exposure studies. Withdrawal-focused sources reported or discussed nonspecific manifestations, including agitation, restlessness, anxiety, craving, and delirium-like presentations, but no validated ICU-specific diagnostic approach or robust prevalence estimate was identified. NRT was the only intervention evaluated.

Smoking-related status was associated with agitation and delirium in several observational studies; however, heterogeneous exposure definitions and inconsistent evidence syntheses preclude causal or general prognostic conclusions. Evidence specific to nicotine withdrawal syndrome was limited, and the effectiveness and safety of NRT remain uncertain. Implications for clinical practice included routine identification of nicotine dependence at ICU admission, early monitoring of withdrawal symptoms, individualisation of sedation management, careful and selective consideration of nicotine replacement therapy (NRT), education of the therapeutic team, planning of further care, and smoking cessation interventions.