Vapotherm to the Rescue: A Case of EVALI with Severe Hypoxemia

Abstract

Acute lung injury in the setting of vaping is a growing epidemic. Eighty percent of patients experiencing pulmonary complications reported using both nicotine and THC/CBD products. Clinically, patients present with cough, chest tightness, dyspnea and wheezing. Life-threatening complications like hypoxemic respiratory failure and death have also been reported. As of September 26th, 2019, the CDC reported 10 deaths in 12 states attributed to lung injury secondary to vaping. We present a case of likely e-cigarette or vaping product-use associated lung injury (EVALI) with profound hypoxemia with early initiation of vapotherm and intravenous corticosteroids. A 30-year-old male with a past medical history of anxiety, alcohol and tobacco use presented to our institution with one week history of dyspnea, cough and chest tightness. Further history revealed active JUUL/Vape use with THC products. On presentation, the patient was noted to be hypoxemic requiring non-rebreather oxygen (NRB). He was febrile to 101.5 F and tachycardic to 127 bpm. Blood work revealed WBC of 19.2 cells/mm 3 with leftward shift. ABG on NRB 15 liters/minute revealed PaO 2 of 64 mmHg. CT chest revealed diffuse bilateral ground glass opacifications with