(929) Impact of Nicotine Withdrawal on Agitation and Sedative Use in Mechanically Ventilated ICU Patients

Introduction: While some countries routinely prescribe nicotine replacement therapy (NRT) to eligible tobacco using intensive care unit (ICU) patients, the effects of abrupt discontinuation of nicotine in this setting are not well understood. Prior studies yield inconclusive results and highlight a need for objective methods to quantify tobacco use status. This study aimed to evaluate the impact of nicotine withdrawal on Richmond Agitation Sedation Scale (RASS) scores and utilization of sedating medications in mechanically ventilated ICU patients. We also report the utility of carboxyhemoglobin (COHb) measurements to qualify patient tobacco use status.

Methods: We conducted a retrospective cohort study evaluating RASS scores, sedating medication use, and COHb levels in ICU patients who were mechanically ventilated at 3 hospitals in Ohio. Data from 1/1/22 to 12/31/22 was retrieved in tobacco (n=130) and non-tobacco (n=406) using patients via electronic medical record review. The primary outcome was the percent of RASS measurements within the clinical goal range. Secondary outcomes included sedating medications and COHb levels on admission.

Results: Baseline demographics for sex, race, and ethnicity were equal between study groups. The percent of RASS measurements within clinical goal range was equal between study groups: 91.3±11.1% of non-tobacco users and 90.0±13.9% of tobacco users were at goal. There were no differences in sedation medication administration between groups. COHb levels were different between groups. 40% of tobacco users had a COHb measurement ≥ 1.5 while only 25.6% of non-tobacco users met this criterion (p < 0.001).

Conclusions: These data show no differences in agitation levels or administration of sedating medications between tobacco using and non-tobacco using mechanically ventilated ICU patients. This suggests no clinically significant influence of ICU nicotine withdrawal and disputes the routine use of NRT. The differences in admission COHb levels between groups suggests possible utility of COHb as a qualitative marker for tobacco use in patients who are unable to provide a tobacco use history due to mechanical ventilation status. Study limitations include data collection via retrospective chart review and inaccurate documentation of tobacco use status in the patient population.