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

Don Hayes; Amy Board; Carolyn S. Calfee; Sascha Ellington; Lori A. Pollack; Hasmeena Kathuria; Michelle N. Eakin; David N. Weissman; Sean J. Callahan; Annette M. Esper; Laura E. Crotty Alexander; Nirmal S. Sharma; Nuala J. Meyer; Lincoln S. Smith; Shannon Novosad; Mary E. Evans; Alyson B. Goodman; Eleanor S. Click; Richard T. Robinson; Gary Ewart; Evelyn Twentyman

doi:10.1016/j.chest.2022.02.039

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

Don Hayes, Amy Board, Carolyn S. Calfee, Sascha Ellington, Lori A. Pollack, Hasmeena Kathuria, Michelle N. Eakin, David N. Weissman, Sean J. Callahan, Annette M. Esper, Laura E. Crotty Alexander, Nirmal S. Sharma, Nuala J. Meyer, Lincoln S. Smith, Shannon Novosad, Mary E. Evans, Alyson B. Goodman, Eleanor S. Click, Richard T. Robinson, Gary EwartEvelyn Twentyman

School of Medicine

Research output: Contribution to journal › Review article › peer-review

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.

Original language	English (US)
Pages (from-to)	256-264
Number of pages	9
Journal	CHEST
Volume	162
Issue number	1
DOIs	https://doi.org/10.1016/j.chest.2022.02.039
State	Published - Jul 2022

Keywords

ICU
critical illness
e-cigarette
lung injury
vaping

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine
Cardiology and Cardiovascular Medicine
Pulmonary and Respiratory Medicine

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10.1016/j.chest.2022.02.039

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Hayes, D., Board, A., Calfee, C. S., Ellington, S., Pollack, L. A., Kathuria, H., Eakin, M. N., Weissman, D. N., Callahan, S. J., Esper, A. M., Crotty Alexander, L. E., Sharma, N. S., Meyer, N. J., Smith, L. S., Novosad, S., Evans, M. E., Goodman, A. B., Click, E. S., Robinson, R. T., ... Twentyman, E. (2022). Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury. CHEST, 162(1), 256-264. https://doi.org/10.1016/j.chest.2022.02.039

Hayes, D, Board, A, Calfee, CS, Ellington, S, Pollack, LA, Kathuria, H, Eakin, MN, Weissman, DN, Callahan, SJ, Esper, AM, Crotty Alexander, LE, Sharma, NS, Meyer, NJ, Smith, LS, Novosad, S, Evans, ME, Goodman, AB, Click, ES, Robinson, RT, Ewart, G & Twentyman, E 2022, 'Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury', CHEST, vol. 162, no. 1, pp. 256-264. https://doi.org/10.1016/j.chest.2022.02.039

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

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",

author = "Don Hayes and Amy Board and Calfee, {Carolyn S.} and Sascha Ellington and Pollack, {Lori A.} and Hasmeena Kathuria and Eakin, {Michelle N.} and Weissman, {David N.} and Callahan, {Sean J.} and Esper, {Annette M.} and {Crotty Alexander}, {Laura E.} and Sharma, {Nirmal S.} and Meyer, {Nuala J.} and Smith, {Lincoln S.} and Shannon Novosad and Evans, {Mary E.} and Goodman, {Alyson B.} and Click, {Eleanor S.} and Robinson, {Richard T.} and Gary Ewart and Evelyn Twentyman",

note = "Publisher Copyright: {\textcopyright} 2022 American College of Chest Physicians",

year = "2022",

month = jul,

doi = "10.1016/j.chest.2022.02.039",

language = "English (US)",

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T1 - Pulmonary and Critical Care Considerations for e-Cigarette, or Vaping, Product Use-Associated Lung Injury

AU - Hayes, Don

AU - Board, Amy

AU - Calfee, Carolyn S.

AU - Ellington, Sascha

AU - Pollack, Lori A.

AU - Kathuria, Hasmeena

AU - Eakin, Michelle N.

AU - Weissman, David N.

AU - Callahan, Sean J.

AU - Esper, Annette M.

AU - Crotty Alexander, Laura E.

AU - Sharma, Nirmal S.

AU - Meyer, Nuala J.

AU - Smith, Lincoln S.

AU - Novosad, Shannon

AU - Evans, Mary E.

AU - Goodman, Alyson B.

AU - Click, Eleanor S.

AU - Robinson, Richard T.

AU - Ewart, Gary

AU - Twentyman, Evelyn

PY - 2022/7

Y1 - 2022/7

N2 - 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.

AB - 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.

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KW - critical illness

KW - e-cigarette

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KW - vaping

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

Abstract

Keywords

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