SynthesisAnnals of the American Thoracic Society2013
Cigarette smoking as a risk factor for delirium in hospitalized and intensive care unit patients. A systematic review.
Synthesis in Annals of the American Thoracic Society, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
17 citing papers in PubMed, 2 syntheses or guidelines pooled it, 44 citations in OpenAlex.
- Five-decade prevalence of delirium in pneumonia, risk factors and associated mortality: a systematic review and meta-analysis.European respiratory review : an official journal of the European Respiratory Society · 2025Pooled it
- Identifying Older Adults at Risk of Delirium Following Elective Surgery: A Systematic Review and Meta-Analysis.Journal of general internal medicine · 2018Pooled it
- Effect of Intensive Psychological Nursing Intervention on HAMD and SF-36 Scores in Patients with Severe Liver Cancer in ICU.Journal of healthcare engineering · 2022Trial
- Nicotine Withdrawal Syndrome in Intensive Care Patients-Preventive and Therapeutic Implications.Medical sciences (Basel, Switzerland) · 2026Review
- Association between nicotine-dependent patients and delirium in intensive care units: a retrospective cohort study using a large clinical database.BMC psychiatry · 2025Article
- Former smoking, but not active smoking, is associated with delirium in postoperative ICU patients: a matched case-control study.Frontiers in psychiatry · 2024Article
- Cigarette smoking is linked to an increased risk of delirium following arthroplasty in patients suffering from osteoarthritic pain.CNS neuroscience & therapeutics · 2023Article
- Incidence, Subtypes, Risk factors, and Outcome of Delirium: A Prospective Observational Study from Indian Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2023Article
- The Association between Electroencephalography with Auditory Steady-State Response and Postoperative Delirium.Journal of personalized medicine · 2022Article
- Associations of Smoking With Delirium and Opioid Use in Older Adults With Traumatic Hip Fracture.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2022Observational
- Nomogram for Prediction of Postoperative Delirium after Deep Brain Stimulation of Subthalamic Nucleus in Parkinson's Disease under General Anesthesia.Parkinson's disease · 2022Article
- Reply to "Perioperative Alcohol Withdrawal Syndrome: Care Based on Empathy plus Prescriptions Based on Physiology".Visceral medicine · 2021Article
- Delirium in medical intensive care units: Incidence, subtypes, risk factors, and outcome.Indian journal of psychiatry · 2019Article
- Intraoperative electroencephalogram suppression at lower volatile anaesthetic concentrations predicts postoperative delirium occurring in the intensive care unit.British journal of anaesthesia · 2018Article
- Cigarette smoking is an independent risk factor for post-stroke delirium.BMC neurology · 2017Article
- Smoking Cessation and the Risk of Hyperactive Delirium in Hospitalized Patients: A Retrospective Study.Canadian journal of psychiatry. Revue canadienne de psychiatrie · 2016Article
- Nicotine replacement therapy for agitation and delirium management in the intensive care unit: a systematic review of the literature.Journal of intensive care · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundActive smokers are prevalent in hospitalized and critically ill patients. Cigarette smoking and nicotine withdrawal may increase delirium in these populations. This systematic review aims to determine whether active cigarette smoking increases the risk for delirium in hospitalized and intensive care unit (ICU) patients.
methodsA systematic search of English-, Spanish-, and French-language articles published from 1966 to April 2013 was performed. Studies were included if they measured cigarette smoking as a risk factor and delirium as an outcome in adult hospitalized or ICU patients. Methodologic quality of studies was assessed using both the validated Newcastle Ottawa Scale and an additional evidence-based quality rating scale.
resultsA total of 14 cohort studies of surgical and ICU populations were included in the review. No studies in non-ICU inpatients were identified. The incidence of delirium ranged from 9 to 52%, and the prevalence of active smokers ranged from 9 to 44%. The quality of assessment for active smoking varied widely. None of the studies used biochemical measures to determine cigarette smoke exposure. Of the six studies restricting the smoking group to active smokers only, active smoking was independently associated with delirium in one study, trended toward an association in one study, and showed a dose response in one study. Quantitative summary measures were not calculated due to study heterogeneity and missing data.
conclusionsThere is currently insufficient evidence to determine if cigarette smoking is a risk factor for delirium. Future studies should consider using biochemical measures of cigarette smoke exposure to objectively quantify smoking behavior.
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