e-cigarette or vaping pulmonary injury

Introduction

in July 2019, a cluster of over 50 cases of acute lung injury in association with the use of e-cigarettes or vaping were identified in the USA¹⁾ mainly in young adults using THC products, by Sept 2019 this had risen to over 500 cases with 7 confirmed deaths
usually gradual onset of symptoms over days to weeks
all had constitutional symptoms and bilateral pulmonary infiltrates with ARDS-like illness and hypoxia and most had GIT symptoms - mainly nausea and vomiting but many had abdominal pain and diarrhoea
most had leukocytosis with neutrophilia and an ESR > 30, some had fevers
a third had mild hyponatraemia and/or hypokalaemia
half required critical care
a third required intubation
median hospitalization was 6 days
17% reported only nicotine use and no THC use
most reported daily use and use within the week prior to onset of symptoms
some report use of Dabbing: superheating substances containing high concentrations of THC or other cannabinoids (e.g., budder, butane hash oil BHO, 710, CBD)

Use of an e-cigarette (vaping) or dabbing in 90 days before symptom onset; and,
Pulmonary infiltrate, such as opacities on plain-film radiograph of the chest or ground-glass opacities on chest CT; and,
No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process), and,
Absence of pulmonary infection on initial workup: the minimum criteria include:
- negative respiratory viral panel and influenza PCR or rapid test if local epidemiology supports testing.
- All other clinically indicated testing for respiratory infectious disease (e.g., urine antigen testing for Streptococcus pneumonia and legionella, sputum culture if productive cough, bronchoalveolarlavage culture if done, blood culture, and presence of HIV-related opportunistic respiratory infections if appropriate) must be negative;

Using an e-cigarette (vaping) or dabbing in 90 days before symptom onset; and,
Pulmonary infiltrate, such as opacities on plain film chest radiograph or ground-glass opacities on chest CT; and
Infection identified by means of culture or PCR, but the clinical team caring for the patient believes that this is not the sole cause of the underlying respiratory disease process; or as the minimum criteria, to rule out pulmonary infection not met (testing not performed) and clinical team caring for the patient believes that this is not the sole cause of the underlying respiratory disease process; and
No evidence in medical record of alternative plausible diagnoses (e.g., cardiac, rheumatologic, or neoplastic process)

supportive care, and if hypoxic respiratory failure, consider intubation and ventilation as per Acute Respiratory Distress Syndrome (ARDS)
exclude infective causes
admit under respiratory unit
consider steroids
check for latest Mx from CDC

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