Rahul Sangani1, Edward Rojas1, Michael Forte1, Rafia Zulfikar1, Nicole Prince2,3, Antonios Tasoglou4, Travis Goldsmith5, Gary Casuccio4, Jonathan Boyd3,5,6,7, I Mark Olfert5,7,8, Melina Flanagan9, Sunil Sharma1. 1. Section of Pulmonary, Critical Care and Sleep Medicine, West Virginia University School of Medicine, Morgantown, WV, USA. 2. C. Eugene Bennett Department of Chemistry, West Virginia University, Morgantown, WV, USA. 3. Department of Orthopedics, West Virginia University School of Medicine, Morgantown, WV, USA. 4. RJ Lee Group, Inc., Monroeville, PA, USA. 5. Department of Physiology and Pharmacology, West Virginia University School of Medicine, Morgantown, WV, USA. 6. Occupational and Environmental Health, West Virginia University School of Public Health, Morgantown, WV, USA. 7. Center of Inhalation Toxicology (Itox, WVU Robert C. Byrd Health Science Center, Morgantown, USA. 8. Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, USA. 9. Department of Pathology, Anatomy, and Laboratory Medicine, School of Medicine, West Virginia University, Morgantown, WV, USA.
Abstract
Background: Electronic cigarette use has increased dramatically since their introduction in 2007. Respiratory complications, particularly lipoid pneumonia, have been reported as early as 2012. An outbreak of pulmonary injury in 2019 has been reported in patients using vaping products.Research Question: To describe a rural Appalachian tertiary center's experience of EVALI and to identify novel mechanisms of pulmonary injury patterns.Study Design and Methods: We present a consecutive case series of 17 patients admitted to our rural, academic, tertiary care institution with EVALI from August 2019 to March 2020. Demographics, baseline characteristics, co-morbidities, vaping behavior, and hospital course were recorded. Broncho-alveolar lavage specimens were assessed for lipid-laden macrophages and hemosiderin-laden macrophages with stains for Oil-Red-O (n = 15) and Prussian Blue (n = 14) respectively.The patient volunteered e-liquid materials (n = 6), and vapors were analyzed using a proton transfer reaction time-of-flight mass spectrometer (PTR-TOF-MS) to describe the chemical profile. Post-discharge interviews were conducted. Results: The most common CT finding was bilateral ground-glass opacities with a predilection for lower lung zones. The most frequent pulmonary injury pattern was lipoid pneumonia. The majority of EVALI patients were critically ill requiring ventilation or ECMO. The most severely ill patients were noted to be positive for iron stains in macrophages and showed higher volatile organic compound (VOC) levels in chemical analysis.Interpretation: Based on our experience, EVALI in rural Appalachia presented with relatively severe respiratory failure. Worse outcomes appear to be correlated to high levels of VOCs, iron deposition in lungs, and concomitant infection.
Background: Electronic cigarette use has increased dramatically since their introduction in 2007. Respiratory complications, particularly lipoid pneumonia, have been reported as early as 2012. An outbreak of pulmonary injury in 2019 has been reported in patients using vaping products.Research Question: To describe a rural Appalachian tertiary center's experience of EVALI and to identify novel mechanisms of pulmonary injury patterns.Study Design and Methods: We present a consecutive case series of 17 patients admitted to our rural, academic, tertiary care institution with EVALI from August 2019 to March 2020. Demographics, baseline characteristics, co-morbidities, vaping behavior, and hospital course were recorded. Broncho-alveolar lavage specimens were assessed for lipid-laden macrophages and hemosiderin-laden macrophages with stains for Oil-Red-O (n = 15) and Prussian Blue (n = 14) respectively.The patient volunteered e-liquid materials (n = 6), and vapors were analyzed using a proton transfer reaction time-of-flight mass spectrometer (PTR-TOF-MS) to describe the chemical profile. Post-discharge interviews were conducted. Results: The most common CT finding was bilateral ground-glass opacities with a predilection for lower lung zones. The most frequent pulmonary injury pattern was lipoid pneumonia. The majority of EVALI patients were critically ill requiring ventilation or ECMO. The most severely ill patients were noted to be positive for iron stains in macrophages and showed higher volatile organic compound (VOC) levels in chemical analysis.Interpretation: Based on our experience, EVALI in rural Appalachia presented with relatively severe respiratory failure. Worse outcomes appear to be correlated to high levels of VOCs, iron deposition in lungs, and concomitant infection.
Authors: Yasmeen M Butt; Maxwell L Smith; Henry D Tazelaar; Laszlo T Vaszar; Karen L Swanson; Matthew J Cecchini; Jennifer M Boland; Melanie C Bois; James H Boyum; Adam T Froemming; Andras Khoor; Isabel Mira-Avendano; Aiyub Patel; Brandon T Larsen Journal: N Engl J Med Date: 2019-10-02 Impact factor: 91.245
Authors: Jennifer E Layden; Isaac Ghinai; Ian Pray; Anne Kimball; Mark Layer; Mark W Tenforde; Livia Navon; Brooke Hoots; Phillip P Salvatore; Megan Elderbrook; Thomas Haupt; Jeffrey Kanne; Megan T Patel; Lori Saathoff-Huber; Brian A King; Josh G Schier; Christina A Mikosz; Jonathan Meiman Journal: N Engl J Med Date: 2019-09-06 Impact factor: 91.245
Authors: Erin D Moritz; Lauren B Zapata; Akaki Lekiachvili; Emily Glidden; Francis B Annor; Angela K Werner; Emily N Ussery; Michelle M Hughes; Anne Kimball; Carla L DeSisto; Brandon Kenemer; Mays Shamout; Macarena C Garcia; Sarah Reagan-Steiner; Emily E Petersen; Emily H Koumans; Matthew D Ritchey; Brian A King; Christopher M Jones; Peter A Briss; Lisa Delaney; Anita Patel; Kara D Polen; Katie Sives; Dana Meaney-Delman; Kevin Chatham-Stephens Journal: MMWR Morb Mortal Wkly Rep Date: 2019-11-01 Impact factor: 17.586