Division of Medical Toxicology, Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
Division of Critical Care Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX.
Pediatr Crit Care Med. 2020 Apr;21(4):385-388. doi: 10.1097/PCC.0000000000002264.
To report a severe case of e-cigarette or vaping product use-associated lung injury with complex course requiring venovenous extracorporeal membrane oxygenation.
Case report.
PICU in an academic medical center.
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.
Venovenous extracorporeal membrane oxygenation MEASUREMENTS 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.
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.
报告一例使用电子烟或蒸气烟产品引起的严重肺损伤病例，该病例病情复杂，需要接受静脉-静脉体外膜肺氧合治疗。
病例报告。
学术医学中心的儿科重症监护病房。
一名 16 岁女孩，因胃肠道和呼吸道症状就诊，入院前出现进行性呼吸衰竭，胸部 CT 显示双侧肺部磨玻璃影。
静脉-静脉体外膜肺氧合。
在广泛的感染性检查结果无明显异常后，患者报告称在出现症状前曾有吸食电子烟的病史，电子烟中含有尼古丁或大麻二酚油。考虑诊断为电子烟或蒸气烟产品引起的肺损伤。儿内科重症监护病房的医护团队在与肺病学和医学毒理学专家协商后，给予患者大剂量静脉内甲泼尼龙 1mg/kg，bid 治疗。尽管初始治疗后患者症状有所改善，但仍需正压通气，并出现纵隔气肿，进展为张力性气胸和持续性气胸漏。由于无法维持氧合，患者需要长时间接受静脉-静脉体外膜肺氧合治疗，并进行了气管造口术。目前，全国范围内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，但电子烟或蒸气烟产品引起的肺损伤的症状还包括全身症状（发热、体重减轻）和胃肠道症状（恶心、呕吐、腹泻）。在许多情况下，使用类固醇可迅速改善临床症状。然而，像我们的患者这样病情严重的其他病例，则需要使用大剂量静脉内类固醇、插管和静脉-静脉体外膜肺氧合治疗。电子烟或蒸气烟产品引起的肺损伤的潜在病因和发病机制尚不清楚。疾病控制和预防中心与州/地方卫生部门和食品药品监督管理局正在积极调查疫情。
临床医生需要意识到当前电子烟或蒸气烟产品引起的肺损伤暴发，并询问出现胃肠道和呼吸道症状的患者是否有吸食电子烟的情况。目前的治疗选择主要为经验性治疗，需要多学科共同参与。
