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Table 2 Nicotine replacement therapy, agitation, delirium, and associated risk factors

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

First author, year (ref no.) Allocation of NRT NRT dose and form Time to NRT therapy (days) Delirium and agitation assessment method Incidence of delirium or agitation Frequency and duration of assessment New psychotropics prescribed
Mayer, 2001 [13] Treatment response to suspected nicotine withdrawal 21-mg patch Range 3–11 Subjective NRT = 100% Sedation, analgesia, or psychotropic use reported
n = 4
Honisett, 2001 [14] Treatment response to suspected nicotine withdrawal Patch dose not reported <2 Subjective description of agitation NRT = 100% Sedation and analgesia
n = 1
Seder, 2010 [15] Clinician discretion 21-mg patch 1–14 Delirium definition provided
Assessment method not reported
NRT = 19%
No NRT = 7%
Cartin-Ceba, 2011 [16] Nurse-driven protocol 21-mg patch (14–21 mg)a <1 RASS
CAM-ICU
Use of physical restraints
RASSa
NRT = −1 (−4 to 0)
No NRT = 0 (−2 to 0)
Positive CAM-ICU days
NRT = 23% (169/734)
No NRT = 13.1% (75/131)
Physical restraint days
NRT = 38% (281/734)
No NRT = 19.5% (112/573)
Worst daily assessment recorded Fentanyl equivalence mcga
NRT = 50 (0–874.9)
No NRT = 0 (0–472)
P < 0.001
Lorazepam equivalence mga
NRT = 0.5 (0–11.5)
No NRT = 0 (0–2.3)
P < 0.001
More quetiapine in NRT group
More dexmedetomidine and haloperidol in no NRT group
Gillies, 2012 [18] Clinician discretion 20-mg patch
(range 10–30 mg)
2.3
(1.5–5.0)a
Validated chart review with prescription of ≥2 anti-agitation drugs as surrogate marker NRT = 25.7%
No NRT = 7.1%
Once per patient NRT = 25.7%
No NRT = 7.1%
Required ≥2 anti-agitation drugs
P < 0.001
Pathak, 2013 [17] Randomised NRT = 21-mg patch
No NRT = placebo
≤2 Analgesia, sedation, and days on ventilator used as surrogate marker Mechanical ventilation daysb
NRT = 1.9 ± 3.7
No NRT = 3.5 ± 5.3
Sedation (days)
NRT = 1.4
No NRT = 2.7
Analgesia (days)
NRT = 1.1
No NRT = 2.1
  1. aMedian (interquartile range)
  2. bMean ± standard deviation