Study: Caffeine and Nicotine Withdrawal May Be Under-Recognized in the ICU

Be sure to tell your doctors and nurses about your smoking and coffee drinking

Photo by Mike Kenneally on Unsplash

It is a common occurrence in the ICU: patients admitted with critical illness can become increasingly agitated, requiring high doses of sedative medications to protect them from self-harm. Many times, it is due to withdrawal from alcohol, and a careful history about alcohol — as well as tobacco — use is an essential part of taking care of patients admitted to the ICU. New research indicates that caffeine withdrawal can be important as well:

Sudden withdrawal from coffee and cigarettes can trigger symptoms that mimic serious disease, leading to unnecessary tests in hospital intensive care units, a new review concludes.
“Nicotine and caffeine are some of the most commonly used and highly addictive substances in modern society, but they are often overlooked as a potential source of significant withdrawal symptoms when abruptly discontinued in ICU,” said review leader Dr. Maya Belitova. She’s an associate professor at Queen Giovanna University Hospital in Sofia, Bulgaria.
Belitova noted withdrawal symptoms, including nausea, vomiting, headaches and delirium, can last for up to two weeks.

The research findings, presented in early June at the European Society of Anesthesiology conference, were eye-opening:

Belitova and her team reviewed 12 studies that examined withdrawal symptoms and treatment in 483 adult ICU patients.
They found that nicotine withdrawal substantially increased agitation (64% for smokers versus 32% for non-smokers), and related displacement of tracheal tube and intravenous lines (14% for smokers versus 3% for non-smokers).
The study also found that caffeine withdrawal in ICU patients led to drowsiness, nausea, vomiting, headaches and increased rates of ICU delirium.

And so, it is very important for clinicians taking care of patients in the ICU, such as myself, to ascertain how much coffee a patient consumes on a daily basis. This is not typically something we think of when we take care of patients in the ICU, and this new research indicates that we should start doing so. Furthermore, since healthcare is a team effort, if we are admitted as patients in the ICU, we should notify the doctors and nurses taking care of us about how much coffee we drink on a daily basis.

For nicotine withdrawal, we routinely will give our patients nicotine patches to treat possible nicotine withdrawal, and this research suggests this is the right thing to do. For caffeine withdrawal, however, we may not be able to do much about caffeine withdrawal, especially if a patient is on a ventilator and cannot take anything by mouth.

There is IV caffeine, believe it or not, but there is very little research on its effectiveness in the ICU. That said, if someone drinks a lot of coffee and has significant agitation in the ICU on a ventilator, perhaps giving coffee may help. It is pretty harmless, and it may prevent the administration of sedative medications that can prolong one’s stay on a ventilator. Definitely some food for thought…