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Review
. 2022 Jul;162(1):256-264.
doi: 10.1016/j.chest.2022.02.039. Epub 2022 Mar 5.

Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury

Don Hayes Jr  1 , Amy Board  2 , Carolyn S Calfee  3 , Sascha Ellington  4 , Lori A Pollack  4 , Hasmeena Kathuria  5 , Michelle N Eakin  6 , David N Weissman  7 , Sean J Callahan  8 , Annette M Esper  9 , Laura E Crotty Alexander  10 , Nirmal S Sharma  11 , Nuala J Meyer  12 , Lincoln S Smith  13 , Shannon Novosad  4 , Mary E Evans  4 , Alyson B Goodman  4 , Eleanor S Click  4 , Richard T Robinson  14 , Gary Ewart  15 , Evelyn Twentyman  4
Affiliations
Review

Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury

Don Hayes Jr et al. Chest. 2022 Jul.

Abstract

Background: In 2019, the United States experienced a nationwide outbreak of e-cigarette, or vaping, product use-associated lung injury (EVALI). More than one-half of these patients required admission to an ICU.

Research question: What are the recent literature and expert opinions which inform the diagnosis and management of patients with critical illness with EVALI?

Study design and methods: To synthesize information critical to pulmonary/critical care specialists in the care of patients with EVALI, this study examined data available from patients hospitalized with EVALI between August 2019 and January 2020; reviewed the clinical course and critical care experience with those patients admitted to the ICU; and compiled opinion of national experts.

Results: Of the 2,708 patients with confirmed or probable EVALI requiring hospitalization as of January 21, 2020, a total of 1,604 (59.2%) had data available on ICU admission; of these, 705 (44.0%) were admitted to the ICU and are included in this analysis. The majority of ICU patients required respiratory support (88.5%) and in severe cases required intubation (36.1%) or extracorporeal membrane oxygenation (6.7%). The majority (93.0%) of these ICU patients survived to discharge. Review of the clinical course and expert opinion provided insight into: imaging; considerations for bronchoscopy; medical treatment, including use of empiric antibiotics, antiviral agents, and corticosteroids; respiratory support, including considerations for intubation, positioning maneuvers, and extracorporeal membrane oxygenation; and patient outcomes.

Interpretation: Review of the clinical course of patients with EVALI requiring ICU admission and compilation of expert opinion provided critical insight into pulmonary/critical care-specific considerations for this patient population. Because a large proportion of patients hospitalized with EVALI required ICU admission, it is important to remain prepared to care for patients with EVALI.

Keywords: ICU; critical illness; e-cigarette; lung injury; vaping.

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