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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Case report
Sedation challenges in patients with E-cigarette, or vaping, product use-associated lung injury (EVALI)
  1. Matthew Antone Maslonka1,
  2. Adam Ross Schertz1,
  3. Lauren Michelle Markowski2 and
  4. Peter John Miller1,3,4
  1. 1Department of Internal Medicine, Section on Pulmonary, Critical Care, Allergy and Immunological Diseases, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  2. 2Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  3. 3Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  4. 4Department of Anesthesiology, Section on Critical Care Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
  1. Correspondence to Dr Peter John Miller; pemiller{at}wakehealth.edu

Abstract

E-cigarette, or vaping, product use-associated lung injury (EVALI) has become an epidemic that is increasingly affecting patients across USA. Recently, over 2100 cases have been reported in 49 states, resulting in at least 42 deaths. We present a case of rapid respiratory failure in an otherwise healthy and young patient who used a vaporiser containing tetrahydrocannabinol (THC) during the month prior to admission. The patient eventually required mechanical ventilation. There were significant challenges in achieving the appropriate level of sedation during intubation and mechanical ventilation. As more EVALI cases are being diagnosed in recent months, we highlight an aspect that may be unique to the population of patients who vaporise THC—high sedative and analgesic requirements during intubation and mechanical ventilation.

  • anaesthesia
  • mechanical ventilation
  • medical management
  • toxicology
  • smoking and tobacco

https://doi.org/10.1136/bcr-2019-233866

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    Footnotes

    • Twitter @Matt_Maslonka

    • Contributors MAM participated in contribution of the work by initiating the planning of the report, assisted in treating the patient, reporting of findings, conception and design for the report, acquisition and review of pertinent literature, and editing/formatting the final version of the case report. ARS participated in contribution of the work by assisting in treating the patient, reporting of findings, conception and design for the report, acquisition and review of pertinent literature, communication for consent, and editing/formatting the final version of the case report. LMM participated in contribution of the work by planning the report, acquisition and review of pertinent literature, and editing/formatting the final version of the case report. PJM participated in contribution of the work by planning the report, assisted in treating the patient, conception and design for the report, and editing/formatting the final version of the case report.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.