Severe acute respiratory distress syndrome requiring extracorporeal membrane oxygenation support: a consequence of vaping

Vaping-Induced Sepsis and Rapidly Evolving Pleural Effusion in a Young, Otherwise Healthy Male

There have been increasing reports of electronic cigarette (e-cigarette) or vaping use-associated lung injury (EVALI), and the evolving literature demonstrates that the solvents used to dissolve flavors, including vitamin E, may be responsible, at least in part, for the injuries associated with this form of smoking. We present the case of a 26-year-old, otherwise healthy, African American male with a history of heavy use-cigarette use who presented with pleuritic chest pain. He was found to be septic and developed a rapidly accumulating pleural effusion with loculations during his hospitalization. He eventually underwent a thoracotomy due to his deteriorating respiratory status. This case highlights the importance of physician awareness regarding the growing evidence base suggesting that electronic cigarettes and vaporized tobacco products are not as safe as they have been perceived to be. Physicians should screen for and advise patients regarding the risks associated with the use of such products.

Association of vaping-related lung injuries with rates of e-cigarette and cannabis use across US states

BACKGROUND AND AIMS

Responses to the 2019 US outbreak of 'e-cigarette or vaping product use-associated lung injury' (EVALI) ranged from temporary restrictions on nicotine e-cigarette sales to critiques of state cannabis policies. However, if either mass-marketed nicotine e-cigarettes or cannabis use per se drove this outbreak, as opposed to an additive in regionally available black-market e-liquids, states' rates of vaping and/or cannabis use should predict their EVALI prevalence. This study tests that relationship.

DESIGN

Observational study of EVALI data from US states' health departments SETTING: United States.

PARTICIPANTS

All US states (n = 50).

MEASUREMENTS

The outcome of interest was each state's total EVALI cases per 12-64-year-old resident-an age group covering most EVALI patients-as reported in the second week of January 2020. Predictors are 2017-18 rates of adult e-cigarette use and past-month cannabis use by state.

FINDINGS

The average state EVALI prevalence was 1.4 cases per 100 000 12-64-year-olds. Maps suggest a high-prevalence cluster comprising seven contiguous states in the northern Midwest. EVALI cases per capita were negatively associated with rates of vaping and past-month cannabis use, with the preferred specification's coefficients at -0.239 [95% confidence interval (CI) = -0.441, -0.037; P = 0.02] and -0.086 (95% CI = -0.141, -0.031; P = 0.003), respectively. Robustness checks supported this finding.

CONCLUSIONS

In the United States, states with higher rates of e-cigarette and cannabis use prior to the 2019 'e-cigarette or vaping product use-associated lung injury' (EVALI) outbreak had lower EVALI prevalence. These results suggest that EVALI cases did not arise from e-cigarette or cannabis use per se, but rather from locally distributed e-liquids or additives most prevalent in the affected areas.