Choe June, Chen Peter, Falk Jeremy A, Nguyen Luan, Ng David, Parimon Tanyalak, Ghandehari Sara
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA.
Department of Pathology, Cedars-Sinai Medical Center, Los Angeles, CA.
Crit Care Explor. 2020 Jan 29;2(1):e0079. doi: 10.1097/CCE.0000000000000079. eCollection 2020 Jan.
Vaping-associated lung injury has rapidly become a nationwide epidemic and a threat to public health. In this case series, we describe unique clinical features of severe vaping-associated lung injury, defined as respiratory failure due to vaping that requires mechanical ventilation.
Clinical observation of four patients.
Case series.
Data and images were extract from medical records after approval was obtained from the institutional review board.
Four patients were admitted to the ICU with severe manifestation of vaping-associated lung injury. Although every case required mechanical ventilatory support (venovenous extracorporeal membrane oxygenation in one patient), all patients survived and were discharged without supplemental oxygen. Systemic corticosteroids were administered in three patients and N-acetyl cysteine in one. A postdischarge pulmonary function test in one patient was normal except for mildly decreased diffusing capacity.
Based on our experience, prognosis of severe vaping-associated lung injury appears favorable with aggressive supportive care, although there is evidence from existing literature that mortality rate might rise with increasing disease severity. Underlying mechanism of lung injury might be similar between vaping-associated lung injury and amiodarone pneumonitis. Foamy or lipid-laden macrophages, seen in both conditions, might be a marker of cytotoxicity from substances contained in e-cigarettes, such as vitamin E acetate. Systemic corticosteroids, and possibly N-acetyl cysteine, could be considered as therapeutic adjuncts in vaping-associated lung injury. Serial pulmonary function tests should be obtained in these patients to monitor for potential long-term complications. The primary limitations of this case series are its small sample and lack of longitudinal follow-up data.
与电子烟相关的肺损伤已迅速成为全国性的流行病，并对公众健康构成威胁。在本病例系列中，我们描述了严重的与电子烟相关的肺损伤的独特临床特征，其定义为因电子烟导致的呼吸衰竭，需要机械通气。
对4例患者的临床观察。
病例系列。
在获得机构审查委员会批准后，从病历中提取数据和图像。
4例患者因严重的与电子烟相关的肺损伤入住重症监护病房。尽管每个病例都需要机械通气支持（1例患者采用静脉-静脉体外膜肺氧合），但所有患者均存活且出院时无需吸氧。3例患者使用了全身糖皮质激素，1例使用了N-乙酰半胱氨酸。1例患者出院后的肺功能测试除弥散能力轻度下降外均正常。
根据我们的经验，尽管现有文献表明死亡率可能会随着疾病严重程度的增加而上升，但积极的支持治疗下，严重的与电子烟相关的肺损伤的预后似乎良好。与电子烟相关的肺损伤和胺碘酮肺炎之间的肺损伤潜在机制可能相似。在这两种情况下都可见到的泡沫状或富含脂质的巨噬细胞，可能是电子烟中所含物质（如醋酸维生素E）细胞毒性的标志物。全身糖皮质激素以及可能的N-乙酰半胱氨酸可被视为与电子烟相关的肺损伤的治疗辅助药物。应在这些患者中进行系列肺功能测试，以监测潜在的长期并发症。本病例系列的主要局限性在于样本量小且缺乏纵向随访数据。
