We report a case of tobacco-addicted woman who has been hospitalized in intensive care unit. During mechanical ventilation, management of sedation was difficult, when she was awake, we observed restlessness associated with failure of the mechanical ventilation weaning. The improvement of restlessness and mechanical ventilation were obtained when we set a transdermal nicotine patch. This observation suggests that the nicotine withdrawal syndrome is an unrecognized cause of restlessness and that the transdermal nicotine patch should be a diagnosis means which is safe, cheap and easy to use.