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

Research output: Contribution to journalReview articlepeer-review


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 languageEnglish (US)
Pages (from-to)256-264
Number of pages9
Issue number1
StatePublished - Jul 2022


  • 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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