Nicotine Withdrawal in the ICU: Evidence Too Thin for Routine NRT

This scoping review maps the fragmented evidence on nicotine withdrawal in critically ill patients and clarifies why nicotine replacement therapy cannot be recommended reflexively for ICU smokers.

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Background Information

Nicotine withdrawal may worsen ICU outcomes without clear treatment protocols.

Nicotine withdrawal in the ICU can complicate treatment due to both psychological and somatic factors. The study found that delirium, agitation, and anxiety are common in ICU patients with nicotine withdrawal, but diagnostic and treatment approaches are inconsistent. Identifying nicotine dependence and monitoring for withdrawal in ICU patients is crucial, although current interventions like nicotine replacement therapy (NRT) lack robust efficacy data. Monitor ICU patients for nicotine withdrawal and individualize sedation and NRT approaches cautiously.

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Authors: Piotrkowska R, Miszewska A, Lange S, Mędrzycka-Dąbrowska W, Krupa-Nurcek S

Citation: Piotrkowska R, Miszewska A, Lange S, et al. Nicotine Withdrawal Syndrome in Intensive Care Patients-Preventive and Therapeutic Implications. Medical sciences (Basel, Switzerland). 2026;14(3). doi:10.3390/medsci14030374

Article Links: PubMed · Journal / DOI · Free Full Text (PMC)

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Executive Summary

Study Design

Patient Population

Primary Outcomes

Secondary Outcomes & Safety Profile

Pharmacist Implications

Clinical Pearls

Limitations

Controversies & Evidence Gaps

Cost & Logistics

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