Department of Pediatrics, Division of Pulmonary and Sleep Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin.
Pediatr Pulmonol. 2020 Jul;55(7):1712-1718. doi: 10.1002/ppul.24787. Epub 2020 Apr 22.
Beginning June 2019, Children's Wisconsin was the first hospital to identify a cohort of adolescent patients hospitalized with symptoms likely associated with e-cigarette use. Our report adds to the growing literature describing the radiographic, gross and cytopathologic bronchoscopic findings, and short-term lung function outcomes in this cohort of adolescents with e-cigarette or vaping product use associated lung injury (EVALI).
We present 15 adolescents hospitalized from June to September, 2019 with confirmed EVALI. We abstracted data from inpatient hospitalization and first outpatient pulmonary clinic visit.
There were 15 patients (11 male, 12 White) with a mean age of 17.1 years. All patients presented with subacute pulmonary, gastrointestinal and constitutional complaints. Diagnostic workup was guided by the Centers for Disease Control criteria for confirmed EVALI case surveillance. Flexible bronchoscopy was performed in 13/15 patients with 10/13 demonstrating gross pathologic abnormalities. Seven of 15 patients required intensive care and 2 met criteria for pediatric Acute Respiratory Distress Syndrome. Patients had dramatic improvement with systemic glucocorticoid therapy and 14/15 were discharged on room air. Eleven patients were seen as outpatients. Despite 11/11 patients reporting resolved or improved symptoms, 7/11 had abnormalities on pulmonary function testing. We initiated inhaled corticosteroids for 5/11 patients and 4/11 patients remained on their corticosteroid wean.
We report short-term outcomes of the first cohort of adolescent patients hospitalized with EVALI. An association is observed between clinical improvement and treatment with systemic corticosteroids. However, residual airway reactivity or diffusion abnormalities persisted when patients were re-evaluated in the short-term period (mean 4.5 weeks).
自 2019 年 6 月以来，威斯康星儿童医院是第一家确定一组因可能与电子烟使用相关的症状而住院的青少年患者的医院。我们的报告增加了越来越多的描述青少年电子烟或蒸气产品使用相关肺损伤（EVALI）患者的放射学、大体和细胞病理学支气管镜检查结果以及短期肺功能结果的文献。
我们报告了 2019 年 6 月至 9 月期间因确诊 EVALI 住院的 15 名青少年。我们从住院和首次门诊肺诊所就诊中提取数据。
共有 15 名患者（11 名男性，12 名白人），平均年龄为 17.1 岁。所有患者均出现亚急性肺部、胃肠道和全身症状。诊断工作由疾病控制中心对确诊 EVALI 病例监测的标准指导。13/15 例患者进行了软性支气管镜检查，10/13 例显示大体病理异常。15 例患者中有 7 例需要重症监护，2 例符合小儿急性呼吸窘迫综合征的标准。患者全身糖皮质激素治疗后明显改善，14/15 例患者在空气病房出院。11 例患者作为门诊患者就诊。尽管 11/11 例患者报告症状缓解或改善，但 7/11 例患者肺功能检查异常。我们为 5/11 例患者开始吸入皮质类固醇，4/11 例患者仍在皮质类固醇减量中。
我们报告了第一组因 EVALI 住院的青少年患者的短期结果。在接受全身皮质类固醇治疗的患者中观察到临床改善与治疗之间的相关性。然而，当患者在短期内（平均 4.5 周）再次评估时，仍然存在气道反应性或弥散异常。
