Evidence map›Paper›PMID 27891229›Full record

ArticleJournal of intensive care2016

Nicotine replacement therapy for agitation and delirium management in the intensive care unit: a systematic review of the literature.

Melanie Kowalski, Andrew A Udy, Hayden J McRobbie, Michael J Dooley

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Journal of intensive care, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 1 pooled it
1.7field-weighted citation impact, top 15% of its field
1 · What the graph read from 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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 1 synthesis or guideline pooled it, 18 citations in OpenAlex.

  1. 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 · 2025
    Pooled it
  2. Review
  3. Article
  4. Article
  5. 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 · 2022
    Observational
  6. Article
  7. Review of the role of cigarette smoking in diabetic foot.Journal of diabetes investigation · 2019
    Review
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

4 authors at 3 institutions in 2 countries.

Melanie KowalskiPharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia ; Intensive Care Unit, Alfred Health, Melbourne, Australia ; Monash University, Melbourne, Australia.ORCID 0000-0002-7067-9114
Andrew A UdyIntensive Care Unit, Alfred Health, Melbourne, Australia ; Monash University, Melbourne, Australia.
Hayden J McRobbieWolfson Institute of Preventive Medicine, London, UK ; Queen Mary University of London, London, UK.
Michael J DooleyPharmacy Department, Alfred Health, 55 Commercial Road, Melbourne, VIC 3004 Australia ; Monash University, Melbourne, Australia.
Alfred Health · AUMonash Alfred Psychiatry Research centre · AUQueen Mary University of London · GB

Funding

Medical Research Council MR/K023195/1
6 · The paper itself

Abstract

backgroundActive smokers are prevalent within the intensive care setting and place a significant burden on healthcare systems. Nicotine withdrawal due to forced abstinence on admission may contribute to increased agitation and delirium in this patient group. The aim of this systematic review was to determine whether management of nicotine withdrawal, with nicotine replacement therapy (NRT), reduces agitation and delirium in critically ill patients admitted to the intensive care unit (ICU).

methodsThe following sources were used in this review: MEDLINE, EMBASE, and CINAHL Plus databases. Included studies reported delirium or agitation outcomes in current smokers, where NRT was used as management of nicotine withdrawal, in the intensive care setting. Studies were included regardless of design or number of participants. Data were extracted on ICU classification; study design; population baseline characteristics; allocation and dose of NRT; agitation and delirium assessment methods; and the frequency of agitation, delirium, and psychotropic medication use.

resultsSix studies were included. NRT was mostly prescribed for smokers with heavier smoking histories. Three studies reported an association between increased agitation or delirium and NRT use; one study could not find any significant benefit or harm from NRT use; and two described a reduction of symptomatic nicotine withdrawal. A lack of consistent and validated assessment measures, combined with limitations in the quality of reported data, contribute to conflicting results.

conclusionsCurrent evidence for the use of NRT in agitation and delirium management in the ICU is inconclusive. An evaluation of risk versus benefit on an individual patient basis should be considered when prescribing NRT. Further studies that consider prognostic balance, adjust for confounders, and employ validated assessment tools are urgently needed.

Indexed as

AgitationCritical careDeliriumIntensive care unitNicotine replacement therapyNicotine withdrawal

Identifiers

PMID27891229
PMCPMC5109763
OpenAlexW2550367436

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.