E-cigarette, or Vaping, Product Use-Associated Lung Injury-Lessons Learned: A Case Series

Abstract

E-cigarette, or vaping, product use has been declared an epidemic, and a new disease has emerged from their use. We describe 4 patients with significant acute lung injury related to e-cigarette use who underwent bronchoscopy and bronchoalveolar lavage. All cases posed anesthetic challenges, including increased airway reactivity, hypoxia, increasing oxygen requirements, and, in 2 severe cases, the need for continued postprocedural mechanical ventilatory support. It is imperative that all members of the treating team are aware of the disproportionate risk of respiratory complications to anticipate the possible need for increased postprocedural respiratory support.

Figure 1.

EVALI manifesting as mild-to-moderate lung disease. A, Sixteen-year-old boy with history of vaping presented with dyspnea, chest pain, fever, and 20-pound weight loss. Axial CT image of the chest in lung window (A) demonstrates ground-glass and wispy linear airspace opacities with a dependent gradient and subpleural sparing (arrowheads). The opacities are more pronounced on the right. B, C, and D, Seventeen-year-old boy with history of vaping presented with increasing dyspnea, 40-pound weight loss, anorexia, nausea, and decreased energy. Posteroanterior chest radiograph (B) demonstrates faint upper lung predominant reticular interstitial opacities (thin arrows). Axial CT image of the chest in lung window (C) demonstrates scattered patchy bilateral ground-glass opacities (arrowheads). Axial CT image of the chest in soft tissue window (D) demonstrates bilateral hilar lymphadenopathy (arrows). CT indicates computed tomography; EVALI, e-cigarette, or vaping, product use-associated lung injury.

Figure 2.

EVALI manifesting as severe lung disease. A, B, and C, Seventeen-year-old girl with history of vaping presented with chest pain, cough, fever, weight loss, and severe respiratory distress. Anteroposterior chest radiograph (A) demonstrates patchy and hazy bilateral airspace opacities in a lower lobe predominant distribution (arrows). Axial and coronal CT images of the chest in lung windows (B and C) demonstrate ground-glass and confluent airspace opacities with a dependent gradient and subpleural sparing (arrowheads). D, E, and F, Seventeen-year-old boy with history of vaping presented with fever, nausea, vomiting left lower quadrant abdominal pain, and diarrhea. Anteroposterior chest radiograph (D) demonstrates diffuse, patchy bilateral airspace opacities (arrows). Axial and coronal CT images of the chest in lung windows (E and F) demonstrate ground-glass and confluent airspace opacities with a dependent gradient and subpleural sparing (arrowheads). CT indicates computed tomography; EVALI, e-cigarette, or vaping, product use-associated lung injury.