Nicotine and caffeine withdrawal can cause unnecessary suffering and testing in intensive care patients

Nicotine and caffeine withdrawal can cause unnecessary suffering for patients in intensive care units, and could lead to unnecessary laboratory and diagnostic imaging tests such as X-rays and MRIs, according to a review systematic clinical and observational studies involving 483 adults. .

The results are presented at this year's Euroanaesthesia congress (the annual meeting of the European Society of Anesthesiology) in Vienna, Austria (1-3 June).

"Nicotine and caffeine are among the most commonly used and highly addictive substances in modern society, but they are often overlooked as a potential source of significant withdrawal symptoms during a sudden withdrawal of treatment. USI, "says Associate Professor Maya Belitova of the Tsaritsa Yoanna University Hospital. -ISUL, Sofia, Bulgaria who led the research.

"Withdrawal symptoms, including nausea, vomiting, headache and delirium, can last up to two weeks.These symptoms resemble conditions such as meningitis, encephalitis, and This can disrupt the clinical diagnosis and lead to unnecessary tests that can harm the patient, cost a lot of money and waste time.

In Europe, up to 27% of the population smoke and more than half drink coffee. The systematic review, which synthesizes all available evidence in the scientific literature, included 12 studies on withdrawal symptoms and ICU treatment between 2000 and 2018 involving 483 adults (aged 18 to 93).

The results showed that acute nicotine withdrawal significantly increased agitation (64% of smokers versus 32% of non-smokers) and the number of tracheal and intravenous line displacements caused by nicotine. agitation in ICU patients (14% of smokers vs. 3% of non-smokers).

However, nicotine replacement therapy has been shown to contribute to the development of delirium in the intensive care unit (severe confusion and disorientation), which is badociated with prolonged intubation, longer duration of stay and higher risk of death.

Sudden withdrawal of caffeine causes drowsiness, nausea, vomiting, headache and may increase delirium rates in the intensive care unit. Caffeine benzoate has been used successfully to treat headaches, but ICU substitution data is limited.

"ICU patients can benefit from nicotine replacement or caffeine supplementation, but with little evidence of their efficacy, this should be left to the judgment of referring physicians," says Professor Belitova . "There is a lack of evidence on caffeine withdrawal, its complications and its therapeutic options.Current research should focus on the acute withdrawal of caffeine as an independent risk factor for agitation and delirium. resuscitation and treatment options available. "