Nicotine Use Disorders: Impact on Critical Illness and Therapeutic Strategies

Nicotine and tobacco use disorders (NTUD) impact multiple organ systems and contribute to neurocognitive, cardiovascular, pulmonary, and endocrine diseases. Nicotine and tobacco products (NTPs) confer a higher risk of cardiovascular complications, respiratory symptom development, as well as exacerbation and sudden death, all of which may necessitate Intensive Care Unit (ICU) admission, including ventilatory and hemodynamic interventions. In addition, the use of nicotine in the form of e-cigarettes has led to e-cigarette/vaping-associated lung injury (EVALI), which often requires ICU admissions, and this entity is associated with high morbidity and mortality. The effects of NTPs on endocrine disorders, renal function, wound healing, and surgical site infections are other aspects of concern in critically ill patients. The clinicians providing care for these patients should have a comprehensive understanding of the disease impact related to the use of NTPs and develop management strategies, taking into consideration the entire gamut of NTUD.