E-cigarette, or vaping, product use-associated lung injury (EVALI) treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO) and ultra-protective ventilator settings.
Mazen Faris OdishAmy BellinghausenEugene GoltsRobert Llewellyn OwensPublished in: BMJ case reports (2020)
A 19-year-old man vaping with tetrahydrocannabinol presented with dyspnoea and right pneumothorax. History, imaging and negative infectious workup were consistent with E-cigarette, or vaping, product use-associated lung injury (EVALI). Treated with systemic steroids, he developed acute respiratory distress syndrome and was intubated requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) by hospital day 3. Using VV-ECMO, very-low tidal volume ventilation of 1.5 cc/kg was achieved, as was daily ambulation. VV-ECMO was decannulated on hospital day 9 and the patient was extubated the next day. He was discharged home on hospital day 13 without oxygen. At post-intensive care unit clinic follow-up, he had lost 20 kg of weight while hospitalised and reported nightmares. Patients with EVALI may be supported with VV-ECMO, which allows ultra-lung-protective mechanical ventilation that may minimise ventilator-induced lung injury. Follow-up in patients with EVALI is essential to diagnose and treat comorbidities, follow lung function and prevent relapses.
Keyphrases
- extracorporeal membrane oxygenation
- acute respiratory distress syndrome
- mechanical ventilation
- respiratory failure
- lung function
- healthcare
- high resolution
- intensive care unit
- acute care
- cystic fibrosis
- chronic obstructive pulmonary disease
- air pollution
- smoking cessation
- adverse drug
- emergency department
- weight loss
- high glucose
- mass spectrometry
- body mass index
- drug induced
- oxidative stress
- weight gain
- newly diagnosed
- carbon dioxide