REBEL Core Cast 23.0 – Vaping Associated Pulmonary Injury

Take Home Points 

  • 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

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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. 


  • 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

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:
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Anand Swaminathan

Clinical Assistant Professor of Emergency Medicine at St. Joe's Regional Medical Center (Paterson, NJ)
REBEL EM Associate Editor and Author

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