Safety of nicotine replacement therapy in critically ill smokers: a retrospective cohort study.

Nicotine replacement therapy (NRT) is a common first-line treatment to prevent nicotine withdrawal in smokers. However, available literature reports conflicting results regarding its efficacy and safety in critically ill patients. The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT. The groups were case-matched for sex, age and Acute Physiology and Chronic Health Evaluation II (APACHE II) score. The primary outcome was administration of antipsychotic medication. Secondary outcomes included use of physical restraints, 30-day mortality, and ventilation requirements. Antipsychotic medication was prescribed in 43 (34.1%) patients who received NRT compared to 14 (11.1%) in controls (P <0.01). Physical restraints were used in 37 (29.4%) patients who received NRT, compared to 12 (9.5%) of controls (P <0.01). The 30-day mortality and number of patients intubated was not statistically different between groups. Average length of intubation time was greater in the NRT group (2.56 days; standard deviation 4.16) compared to the control group (1.44 days; standard deviation 2.68) (P=0.012). The use of NRT to prevent nicotine withdrawal in ICU patients is associated with increased use of antipsychotic medication and physical restraint, and with prolonged mechanical ventilation.

Small animal traversing gamma counter.

A whole body traverser was developed that provides a variety of radionuclide detection configurations for retention and distribution studies. Data from biologically incorporated radionuclides were shown to be less susceptible to geometrical problems with this whole body traverser than with the usual forms of whole body counters. When used in its fully rotational mode, the effects of photon energy and attenuation due to various body tissues, thicknesses, and radionuclide locations were minimized. Consistent presentation of all aspects of the sample produced greater than 95% correlation with the predictable data and less than 2% counting fluctuations. The whole body traverser was utilized in radiolabeled microsphere tracer studies for the determination of regional blood flow and as a static counter for long term retention studies.