Severe E-Cigarette, or Vaping, Product Use Associated Lung Injury Requiring Venovenous Extracorporeal Membrane Oxygenation
Severe E-Cigarette, or Vaping, Product Use Associated Lung Injury Requiring Venovenous Extracorporeal Membrane Oxygenation
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DOI：
10.1097/pcc.0000000000002264
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发表时间：
2020-04-01
影响因子：
4.1
通讯作者：
Hsu, Stephanie
中科院分区：
文献类型：
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作者：
Aldy, Kim;Cao, Dazhe James;Hsu, Stephanie
目的：报道一例严重的电子烟或蒸发产品使用相关肺损伤的病例，其病程复杂，需要静脉体外膜肺氧合。设计：病例报告。背景：在一家学术医学中心的PICU。患者：一名16岁的女孩，出现胃肠道和呼吸道症状，因进行性呼吸衰竭和双侧肺磨玻璃样胸部CT表现而住进我们的PICU。干预：静脉静脉体外膜氧合测量和主要结果：在广泛的感染检查后，她报告了在症状出现之前蒸发电子烟的病史，其中含有尼古丁或三角洲-9-四氢大麻酚油。她被推定为电子烟或蒸发产品使用相关的肺损伤。PICU小组在咨询了肺病学和医学毒理学后，开始大剂量静脉注射甲基强的松龙1 mg/kg，每天两次。尽管最初有所改善，但她继续需要正压通气，并发展为纵隔气肿，进展为张力性气胸和持续的空气泄漏。由于无法维持氧合，她接受了长时间的静脉静脉体外膜肺氧合，并进行了气管切开术。全国各地受影响患者的临床病程、严重程度和干预范围差异很大。呼吸道症状是最严重的，但与电子烟或蒸发产品使用相关的肺损伤的一系列症状包括体质症状(发烧、体重减轻)和胃肠道症状(恶心、呕吐、腹泻)。在许多情况下，类固醇的使用导致了临床的迅速改善。然而，其他重症患者，如我们的患者，需要大剂量静脉注射类固醇、插管和静脉静脉体外膜肺氧合。电子烟或蒸发产品使用相关肺损伤的根本病因和病理生理学仍不清楚。疾病控制和预防中心联合州/地方卫生部门和食品和药物管理局正在积极调查这起疫情。结论：临床医生需要了解当前与电子烟或蒸发产品使用相关的肺损伤的爆发，并询问出现胃肠道和呼吸道症状的患者的蒸发情况。治疗选择是轶事，需要多学科的方法。
Objectives:To report a severe case of e-cigarette or vaping product use-associated lung injury with complex course requiring venovenous extracorporeal membrane oxygenation.Design:Case report.Setting:PICU in an academic medical center.Patients:A 16-year-old girl presenting with gastrointestinal and respiratory symptoms was admitted to our PICU after having progressive respiratory failure and bilateral pulmonary ground-glass opacities on chest CT.Interventions:Venovenous extracorporeal membrane oxygenationMeasurements and Main Results:After extensive infectious workup was unrevealing, she reported a history of vaping e-cigarette containing either nicotine or delta-9-tetrahydrocannabinol oil prior to symptom onset. She was given a presumptive diagnosis of e-cigarette or vaping product use-associated lung injury. The PICU team in consultation with pulmonology and medical toxicology started high-dose IV methylprednisolone 1 mg/kg bid. Despite initial improvements, she continued to require positive pressure ventilation and developed pneumomediastinum with progression to tension pneumothoraces and a persistent air leak. Unable to maintain her oxygenation, she was placed on venovenous extracorporeal membrane oxygenation for a prolonged course and had a tracheostomy placement. The clinical course, severity, and range of interventions in affected patients around the country have varied widely. Respiratory symptoms have been the most severe, but the constellation of symptoms in e-cigarette or vaping product use-associated lung injury include constitutional symptoms (fevers, weight-loss) and gastrointestinal symptoms (nausea, vomiting, diarrhea). In many cases, steroid use led to rapid clinical improvements. However, other cases with severe illness, like our patient, necessitated high-dose IV steroids, intubation, and venovenous extracorporeal membrane oxygenation. The underlying etiology and pathophysiology of e-cigarette or vaping product use-associated lung injury remains unknown. The Centers for Disease Control and Prevention in conjunction with state/local health departments and the Food and Drug Administration is actively investigating the outbreak.Conclusions:Clinicians need to be aware of the current outbreak of e-cigarette or vaping product use-associated lung injury and ask about vaping in patients presenting with gastrointestinal and respiratory symptoms. Treatment options are anecdotal and necessitate a multidisciplinary approach.