nicotine withdrawal and agitation in ventilated critically ill patients尼古丁戒断和搅拌通风危重病人.pdfVIP

Lucidarme et al. Critical Care 2010, 14:R58 /content/14/2/R58 R E S E A R C H Open Access Research Nicotine withdrawal and agitation in ventilated critically ill patients 1 2 2 2 2 1 Olivier Lucidarme , Amélie Seguin , Cédric Daubin , Michel Ramakers , Nicolas Terzi , Patrice Beck , 2 2,3 Pierre Charbonneau and Damien du Cheyron* Abstract Introduction: Smoking is highly addictive, and nicotine abstinence is associated with withdrawal syndrome in hospitalized patients. In this study, we aimed to evaluate the impact of sudden nicotine abstinence on the development of agitation and delirium, and on morbidities and outcomes in critically ill patients who required respiratory support, either noninvasive ventilation or intubation, and mechanical ventilation. Methods: We conducted a prospective, observational study in two intensive care units (ICUs). The 144 consecutive patients admitted to ICUs and requiring mechanical ventilation for 48 hours were included. Smoking status was assessed at ICU admission by using the Fagerström Test of Nicotine Dependence (FTND). Agitation, with the Sedation- Agitation Scale (SAS), and delirium, with the Intensive Care Delirium Screening Checklist (ICDSC), were tested twice daily during the ICU stay. Agitation and delirium were defined by SAS 4 and ICDSC 4, respectively. Nosocomial complications and outcomes were evaluated. Results: Smokers (n = 44) were younger and more frequently male and were more likely to have a history of alcoholism and to have septic shock as the reason for ICU admission than were nonsmokers. The incidence of agitation, but not delirium, increased significantly in the smoker grou