- Ask the patient if they vape!
- Worry about the sick looking patient and those seen recently
- CXR is nonspecific and CT might tell you what’s going on
- Start antibiotics and if you have strong suspicions of vaping give steroids
REBEL Core Cast 23.0 – Vaping Associated Pulmonary Injury
Click here for Direct Download of Podcast
Vaping Associated Pulmonary Injury
- A heterogeneous group of inhalation injuries linked to vaping
- Usually present with constitutional symptoms
- Body aches, fatigue, chills, and malaise are common.
- Cough, shortness of breath and hemoptysis.
- 80% are presenting with GI symptoms, nausea, vomiting diarrhea, abdominal pain.
- More common in males and the vast majority are under 34 years old.
- Make sure to ask young folk about vaping.
- Suspect it in otherwise healthy young individuals.
Lab Testing
- No specific test to diagnose VAPI
- 90% will have elevated WBC
- The majority have a neutrophil predominance
- Mild elevation in ESR and CRP
- Pro-calcitonin typically within normal range
VAPI v. Viral Syndrome
- Quite a bit of overlap
- Remember to ask specific questions about whether the patient vapes
- Patients that come in with vaping injury are quite sick and the majority of them get admitted to the hospital.
Imaging Findings
- CXR can have abnormal findings such as bilateral infiltrate though can have normal Xray early on in the presentation.
- CT scan is not specific for VAPI.
- Usually, find bilateral grand glass opacity
- Crazy paving pattern – affected lung tissue adjacent to unaffected lung tissue
- Most of the patients have lipoid pneumonia but can be nonspecific.
Treatment
- No evidence-based treatment at this time, recommendations are from an expert panel.
- The best recommendation is to treat with steroids and to give antibiotics until you’ve ruled out the infectious process.
- All patients will require supportive care and if really sick we require mechanical ventilation and even ECMO.
Links & Resources
- emDOCs: Vaping Associated Pulmonary Injury, 2019 outbreak
- CoreEM: Vaping Associated Lung Injury
- CDC: Outbreak of Lung Injury Associated with the Use of E-Cigarette, or Vaping, Products
Shownotes Written By: Miguel Reyes, MD (Twitter: @miguel_reyesMD)
Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)
Cite this article as: Anand Swaminathan, "REBEL Core Cast 23.0 – Vaping Associated Pulmonary Injury", REBEL EM blog, December 11, 2019. Available at: https://rebelem.com/rebel-core-cast-23-0-vaping-associated-lung-injury/.
