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Case report
E-cigarette, or vaping, product use-associated lung injury (EVALI) treated with veno-venous extracorporeal membrane oxygenation (VV-ECMO) and ultra-protective ventilator settings
  1. Mazen Faris Odish1,
  2. Amy Bellinghausen1,
  3. Eugene Golts2 and
  4. Robert Llewellyn Owens1
  1. 1Division of Pulmonary, Critical Care, and Sleep Medicine, University of California San Diego, La Jolla, California, USA
  2. 2Division of Cardiovascular and Thoracic Surgery, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Mazen Faris Odish; modish{at}health.ucsd.edu

Abstract

A 19-year-old man vaping with tetrahydrocannabinol presented with dyspnoea and right pneumothorax. History, imaging and negative infectious workup were consistent with E-cigarette, or vaping, product use-associated lung injury (EVALI). Treated with systemic steroids, he developed acute respiratory distress syndrome and was intubated requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO) by hospital day 3. Using VV-ECMO, very-low tidal volume ventilation of 1.5 cc/kg was achieved, as was daily ambulation. VV-ECMO was decannulated on hospital day 9 and the patient was extubated the next day. He was discharged home on hospital day 13 without oxygen. At post-intensive care unit clinic follow-up, he had lost 20 kg of weight while hospitalised and reported nightmares. Patients with EVALI may be supported with VV-ECMO, which allows ultra-lung-protective mechanical ventilation that may minimise ventilator-induced lung injury. Follow-up in patients with EVALI is essential to diagnose and treat comorbidities, follow lung function and prevent relapses.

  • smoking and tobacco
  • mechanical ventilation
  • global health
  • respiratory medicine
  • cardiothoracic surgery
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Footnotes

  • Contributors All authors made individual contributions to the writing of this case report, and approve of the version submitted. MFO contributed to the abstract, summary, background, case presentation and discussion. AB contributed to the discussion and patient perspective. EG contributed to the case presentation and discussion. RLO contributed to the abstract, summary, background, case presentation and discussion.

  • Funding This study was funded by National Heart, Lung, and Blood Institute (T32HL134632) and National Institute of General Medical Sciences (T32GM121318).

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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

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