In mechanically ventilated patients, sudden nicotine abstinence was associated with severe agitation and its consequences, such as self-removal of tubes and catheters.
Agitation was associated with a higher adverse-event rate, such as accidental self-removal of tubes and catheters, and new interventions including supplemental sedation and physical restraint.
Self-removal of the catheter occurred in one patient in each group, and spontaneous dislodgement was observed in one patient in the 5 Fr catheter group.
Subcutaneous screw placement has been found to be an optimal method, in which self-removal of the screw was not possible.
Self-extubation or the unexpected self-removal of the nasogastric cannula or venous access were considered a failure of the drug, as was persistent agitation defined by an RASS score >1.
This is an important patient safety concern because behaviors such as aggressive behavior against care givers or self-removal of an important tube or catheter can have serious consequences [ 52- 55].
In our study, smoking abstinence, even in patients with weak tobacco dependency, was associated with agitation and then self-removal of catheters and tubes, as already reported [ 13, 26, 28].
We hypothesized that dependent smokers may have increased risk for agitation and delirium, and then increased morbidity, such as infections and accidental self-removal of tubes and catheters, related to these behavioral disorders.
Nicotine abstinence was associated with higher incidences of self-removal of tubes and catheters, and with more interventions, including the need for supplemental sedatives, analgesics, neuroleptics, and physical restraints.
Nicotine withdrawal was associated with agitation, but not with delirium, and smokers had a greater frequency of adverse events, such as accidental self-removal of tubes and catheters, and new interventions including supplemental sedation and physical restraint related to agitation events.
