Nicotine Replacement Therapy in the Intensive Care Unit

NCT ID: NCT01362959

Last Updated: 2018-10-10

Study Results

Results available

Outcome measurements, participant flow, baseline characteristics, and adverse events have been published for this study.

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

PHASE4

Total Enrollment

47 participants

Study Classification

INTERVENTIONAL

Study Start Date

2012-06-30

Study Completion Date

2016-08-31

Brief Summary

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The purpose of this study is to determine whether transdermal nicotine replacement therapy is safe and effective for treating nicotine withdrawal symptoms in the critically ill smoking patient.

Detailed Description

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Cigarette smoking remains the leading cause of preventable disease and premature death worldwide. There are about 1.2 billion smokers in the world, half of whom will die from diseases caused by smoking. Smoking causes 5 million deaths per year, and if present trends continue, 10 million smokers per year are projected to die by 2025.

Furthermore, abstinence from the highly addictive tobacco products can lead to withdrawal symptoms. Although these symptoms are non-life threatening in healthy and hospitalized adults they are not well described in the mechanically ventilated active smoking patient.

Retrospective studies found a higher, lower or equal mortality in critically ill patients receiving nicotine replacement therapy compared to patients receiving no nicotine replacement.

Because of these conflicting results and the absence of a randomized controlled trial studying the efficacy and safety of transdermal nicotine replacement therapy in the critically ill smoking patient a clinical study will be conducted.

Conditions

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Delirium Psychomotor Agitation Substance Withdrawal Syndrome Nicotine Replacement Therapy

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

QUADRUPLE

Participants Caregivers Investigators Outcome Assessors

Study Groups

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Nicotine patch

Group Type EXPERIMENTAL

Transdermal nicotine patch

Intervention Type DRUG

The test product is a transdermal nicotine patch. The dosage of the test product depends on the amount of cigarettes used by a specific patient (21 or more or less than 21) delivering 21 or 14 mg nicotine/24 hrs. During the study period of thirty (30) days a patch will be applicated daily.

Control patch

The control product is a look-alike patch compared to the test product, containing no nicotine or other active substances.

Group Type PLACEBO_COMPARATOR

Cutaneous patch, containing no active substances

Intervention Type OTHER

During the study period of thirty (30) days, the control product will be applicated daily.

Interventions

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Transdermal nicotine patch

The test product is a transdermal nicotine patch. The dosage of the test product depends on the amount of cigarettes used by a specific patient (21 or more or less than 21) delivering 21 or 14 mg nicotine/24 hrs. During the study period of thirty (30) days a patch will be applicated daily.

Intervention Type DRUG

Cutaneous patch, containing no active substances

During the study period of thirty (30) days, the control product will be applicated daily.

Intervention Type OTHER

Other Intervention Names

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Nicotinell patch, regulated delivery 35 mg. RVG 14830 Nicotinell patch, regulated delivery 52.5 mg. RVG 14831

Eligibility Criteria

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Inclusion Criteria

* Critically ill active smoking patient
* Being mechanically ventilated
* Start of study product application within 48 hours after ICU admission
* Expected to be mechanically ventilated for more than 48 hours after start of application of the study product

Exclusion Criteria

* Patient younger than 18 years
* Patient or next of kin denying research authorization
* Pregnancy
* Breastfeeding women
* History of chronic dementia or psychosis
* (Acute) neurologic disease on admission, possibly confounding study objectives (TBI, stroke, ICH/SAH, seizures, meningitis, encephalitis, intracranial tumor)
* Patient receiving any form of NRT within two weeks before admission
* Patient not understanding Dutch
* Patient with acute myocardial infarction
* Patient with severe cardiac arrhythmia
* Patient with unstable or deteriorating angina pectoris
* Patient with generalized acute or chronic skin diseases interfering with NRT absorption
* Patient with severe hearing deficiency
* Moribund patient
* Patient with known hypersensibility to nicotine or components of the transdermal therapeutic system
* Patient with known hypersensibility to patches
* Patient participating in an other study
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Deventer Ziekenhuis

OTHER

Sponsor Role collaborator

Wageningen University

OTHER

Sponsor Role collaborator

Gelderse Vallei Hospital

OTHER

Sponsor Role lead

Responsible Party

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drs. B. de Jong

MD

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Ben Jong,de, MD

Role: PRINCIPAL_INVESTIGATOR

Gelderse Vallei Hospital

Locations

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Gelderse Vallei Hospital

Ede, Gelderland, Netherlands

Site Status

Deventer Hospital

Deventer, Overijssel, Netherlands

Site Status

Countries

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Netherlands

References

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Hays JT, Ebbert JO. Adverse effects and tolerability of medications for the treatment of tobacco use and dependence. Drugs. 2010 Dec 24;70(18):2357-72. doi: 10.2165/11538190-000000000-00000.

Reference Type BACKGROUND
PMID: 21142259 (View on PubMed)

Moss M, Burnham EL. Alcohol abuse in the critically ill patient. Lancet. 2006 Dec 23;368(9554):2231-42. doi: 10.1016/S0140-6736(06)69490-7.

Reference Type BACKGROUND
PMID: 17189035 (View on PubMed)

Benowitz NL. Nicotine addiction. N Engl J Med. 2010 Jun 17;362(24):2295-303. doi: 10.1056/NEJMra0809890. No abstract available.

Reference Type BACKGROUND
PMID: 20554984 (View on PubMed)

Hatsukami DK, Stead LF, Gupta PC. Tobacco addiction. Lancet. 2008 Jun 14;371(9629):2027-38. doi: 10.1016/S0140-6736(08)60871-5.

Reference Type BACKGROUND
PMID: 18555914 (View on PubMed)

Mills EJ, Wu P, Lockhart I, Wilson K, Ebbert JO. Adverse events associated with nicotine replacement therapy (NRT) for smoking cessation. A systematic review and meta-analysis of one hundred and twenty studies involving 177,390 individuals. Tob Induc Dis. 2010 Jul 13;8(1):8. doi: 10.1186/1617-9625-8-8.

Reference Type BACKGROUND
PMID: 20626883 (View on PubMed)

Lucidarme O, Seguin A, Daubin C, Ramakers M, Terzi N, Beck P, Charbonneau P, du Cheyron D. Nicotine withdrawal and agitation in ventilated critically ill patients. Crit Care. 2010;14(2):R58. doi: 10.1186/cc8954. Epub 2010 Apr 9.

Reference Type BACKGROUND
PMID: 20380688 (View on PubMed)

Mayer SA, Chong JY, Ridgway E, Min KC, Commichau C, Bernardini GL. Delirium from nicotine withdrawal in neuro-ICU patients. Neurology. 2001 Aug 14;57(3):551-3. doi: 10.1212/wnl.57.3.551.

Reference Type BACKGROUND
PMID: 11502936 (View on PubMed)

Moreno R, Vincent JL, Matos R, Mendonca A, Cantraine F, Thijs L, Takala J, Sprung C, Antonelli M, Bruining H, Willatts S. The use of maximum SOFA score to quantify organ dysfunction/failure in intensive care. Results of a prospective, multicentre study. Working Group on Sepsis related Problems of the ESICM. Intensive Care Med. 1999 Jul;25(7):686-96. doi: 10.1007/s001340050931.

Reference Type BACKGROUND
PMID: 10470572 (View on PubMed)

Lee AH, Afessa B. The association of nicotine replacement therapy with mortality in a medical intensive care unit. Crit Care Med. 2007 Jun;35(6):1517-21. doi: 10.1097/01.CCM.0000266537.86437.38.

Reference Type BACKGROUND
PMID: 17452926 (View on PubMed)

Paciullo CA, Short MR, Steinke DT, Jennings HR. Impact of nicotine replacement therapy on postoperative mortality following coronary artery bypass graft surgery. Ann Pharmacother. 2009 Jul;43(7):1197-202. doi: 10.1345/aph.1L423. Epub 2009 Jun 30.

Reference Type BACKGROUND
PMID: 19567657 (View on PubMed)

Seder DB, Schmidt JM, Badjatia N, Fernandez L, Rincon F, Claassen J, Gordon E, Carrera E, Kurtz P, Lee K, Connolly ES, Mayer SA. Transdermal nicotine replacement therapy in cigarette smokers with acute subarachnoid hemorrhage. Neurocrit Care. 2011 Feb;14(1):77-83. doi: 10.1007/s12028-010-9456-9.

Reference Type BACKGROUND
PMID: 20949331 (View on PubMed)

Cartin-Ceba R, Warner DO, Hays JT, Afessa B. Nicotine replacement therapy in critically ill patients: a prospective observational cohort study. Crit Care Med. 2011 Jul;39(7):1635-40. doi: 10.1097/CCM.0b013e31821867b8.

Reference Type BACKGROUND
PMID: 21494111 (View on PubMed)

Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008 Jun;36(5):309-32. doi: 10.1016/j.ajic.2008.03.002. No abstract available.

Reference Type BACKGROUND
PMID: 18538699 (View on PubMed)

Centers for Disease Control and Prevention (CDC). Vital signs: central line-associated blood stream infections--United States, 2001, 2008, and 2009. MMWR Morb Mortal Wkly Rep. 2011 Mar 4;60(8):243-8.

Reference Type BACKGROUND
PMID: 21368740 (View on PubMed)

Hsieh SJ, Ware LB, Eisner MD, Yu L, Jacob P 3rd, Havel C, Goniewicz ML, Matthay MA, Benowitz NL, Calfee CS. Biomarkers increase detection of active smoking and secondhand smoke exposure in critically ill patients. Crit Care Med. 2011 Jan;39(1):40-5. doi: 10.1097/CCM.0b013e3181fa4196.

Reference Type BACKGROUND
PMID: 20935560 (View on PubMed)

de Jong B, Schuppers AS, Kruisdijk-Gerritsen A, Arbouw MEL, van den Oever HLA, van Zanten ARH. The safety and efficacy of nicotine replacement therapy in the intensive care unit: a randomised controlled pilot study. Ann Intensive Care. 2018 Jun 7;8(1):70. doi: 10.1186/s13613-018-0399-1.

Reference Type DERIVED
PMID: 29881956 (View on PubMed)

Related Links

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http://www.geldersevallei.nl

Website Gelderse Vallei Hospital

Other Identifiers

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2011-002458-29

Identifier Type: EUDRACT_NUMBER

Identifier Source: secondary_id

NicGoWell1.0

Identifier Type: -

Identifier Source: org_study_id

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