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Clinical presentation, treatment, and short-term outcomes of lung injury associated with e-cigarettes or vaping: a prospective observational cohort study.
The Lancet ( IF 98.4 ) Pub Date : 2019-11-08 , DOI: 10.1016/s0140-6736(19)32679-0 Denitza P Blagev 1 , Dixie Harris 2 , Angela C Dunn 3 , David W Guidry 2 , Colin K Grissom 1 , Michael J Lanspa 4
The Lancet ( IF 98.4 ) Pub Date : 2019-11-08 , DOI: 10.1016/s0140-6736(19)32679-0 Denitza P Blagev 1 , Dixie Harris 2 , Angela C Dunn 3 , David W Guidry 2 , Colin K Grissom 1 , Michael J Lanspa 4
Affiliation
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BACKGROUND
An ongoing outbreak of lung injury associated with e-cigarettes or vaping (also known as E-VALI or VALI) started in March, 2019, in the USA. The cause, diagnosis, treatment, and course of this disease remains unknown.
METHODS
In this multicentre, prospective, observational, cohort study, we collected data on all patients with lung injury associated with e-cigarettes or vaping seen in Intermountain Healthcare, an integrated health system based in Utah, USA, between June 27 and Oct 4, 2019. Telecritical care, based in Salt Lake City, UT, USA, was used as the central repository for case validation, public reporting, and system-wide dissemination of expertise, which included a proposed diagnosis and treatment guideline for lung injury associated with e-cigarettes or vaping. We extracted data on patient presentation, treatment, and short-term follow-up (2 weeks after discharge) from chart review and interviews with patients undertaken by the Utah Department of Health (Salt Lake City, UT, USA).
FINDINGS
60 patients presented with lung injury associated with e-cigarettes or vaping at 13 hospitals or outpatient clinics in the integrated health system. 33 (55%) of 60 were admitted to an intensive care unit (ICU). 53 (88%) of 60 patients presented with constitutional symptoms, 59 (98%) with respiratory symptoms, and 54 (90%) with gastrointestinal symptoms. 54 (90%) of 60 were given antibiotics and 57 (95%) were given steroids. Six (10%) of 60 patients were readmitted to an ICU or hospital within 2 weeks, three (50%) of whom had relapsed with vaping or e-cigarette use. Of 26 patients who were followed up within 2 weeks, despite clinical and radiographic improvement in all, many had residual abnormalities on chest radiographs (ten [67%] of 15) and pulmonary function tests (six [67%] of nine). Two patients died and lung injury associated with e-cigarettes or vaping was thought to be a contributing factor, but not the cause of death, for both.
INTERPRETATION
Lung injury associated with e-cigarettes or vaping is an emerging illness associated with severe lung injury and constitutional and gastrointestinal symptoms. Increased awareness has led to identification of a broad spectrum of severity of illness in patients who were treated with antibiotics and steroids. Despite improvement, at short-term follow-up many patients had residual abnormalities. Lung injury associated with e-cigarettes or vaping remains a clinical diagnosis with symptoms that overlap infectious and other lung diseases. Maintaining a high index of suspicion for this disease is important as work continues in understanding the cause or causes, optimal therapy, and long-term outcomes of these patients.
FUNDING
Intermountain Healthcare.
中文翻译：
与电子烟或雾化有关的肺损伤的临床表现，治疗和短期结果：一项前瞻性观察性队列研究。
背景技术与电子烟或电子烟（也称为E-VALI或VALI）相关的持续性肺损伤暴发始于2019年3月，在美国。这种疾病的病因，诊断，治疗和病程仍然未知。方法在这项多中心，前瞻性，观察性队列研究中，我们收集了6月27日至10月4日在美国犹他州的一个综合卫生系统Intermountain Healthcare中发现的所有与电子烟或雾化有关的肺损伤患者的数据。 2019年。总部位于美国犹他州盐湖城的远程危重病护理被用作病例验证，公共报告和全系统专业知识传播的中央存储库，其中包括针对与电子病相关的肺损伤的诊断和治疗指南-香烟或电子烟。我们提取了有关患者表现，治疗，以及从犹他州卫生署（美国犹他州盐湖城）进行的图表审查和患者访谈中进行的短期随访（出院后2周）。结果在综合卫生系统的13家医院或门诊中，有60例因电子烟或雾化引起的肺损伤。60例中有33例（55％）进入了重症监护病房（ICU）。60例患者中有53例（88％）出现体质症状，59例（98％）出现呼吸道症状，54例（90％）出现胃肠道症状。60种药物中有54种（90％）被给予了抗生素，而57种药物（95％）被给予了类固醇。60名患者中有6名（10％）在2周内再次入住ICU或医院，其中三名（50％）因使用电子烟或使用电子烟而复发。尽管在临床和影像学上均有改善，但在2周内随访的26例患者中，许多人的胸部X光片（15例中的10例[67％]）和肺功能检查（9例中的6例[67％]）具有残留异常。两名患者死亡，并且与电子烟或雾化有关的肺部损伤被认为是促成因素，但不是导致死亡的原因。解释与电子烟或电子烟相关的肺损伤是与严重的肺损伤以及体质和胃肠道症状相关的新兴疾病。认识的提高已导致鉴定出接受抗生素和类固醇治疗的患者的各种疾病严重程度。尽管有所改善，但在短期随访中，许多患者仍有残余异常。与电子烟或电子烟相关的肺损伤仍然是一种临床诊断，其症状与传染病和其他肺部疾病重叠。在继续了解这些患者的病因，最佳治疗方法和长期预后方面，保持对该疾病的高度怀疑很重要。资金Intermountain Healthcare。
更新日期：2019-12-06
中文翻译：
与电子烟或雾化有关的肺损伤的临床表现，治疗和短期结果：一项前瞻性观察性队列研究。
背景技术与电子烟或电子烟（也称为E-VALI或VALI）相关的持续性肺损伤暴发始于2019年3月，在美国。这种疾病的病因，诊断，治疗和病程仍然未知。方法在这项多中心，前瞻性，观察性队列研究中，我们收集了6月27日至10月4日在美国犹他州的一个综合卫生系统Intermountain Healthcare中发现的所有与电子烟或雾化有关的肺损伤患者的数据。 2019年。总部位于美国犹他州盐湖城的远程危重病护理被用作病例验证，公共报告和全系统专业知识传播的中央存储库，其中包括针对与电子病相关的肺损伤的诊断和治疗指南-香烟或电子烟。我们提取了有关患者表现，治疗，以及从犹他州卫生署（美国犹他州盐湖城）进行的图表审查和患者访谈中进行的短期随访（出院后2周）。结果在综合卫生系统的13家医院或门诊中，有60例因电子烟或雾化引起的肺损伤。60例中有33例（55％）进入了重症监护病房（ICU）。60例患者中有53例（88％）出现体质症状，59例（98％）出现呼吸道症状，54例（90％）出现胃肠道症状。60种药物中有54种（90％）被给予了抗生素，而57种药物（95％）被给予了类固醇。60名患者中有6名（10％）在2周内再次入住ICU或医院，其中三名（50％）因使用电子烟或使用电子烟而复发。尽管在临床和影像学上均有改善，但在2周内随访的26例患者中，许多人的胸部X光片（15例中的10例[67％]）和肺功能检查（9例中的6例[67％]）具有残留异常。两名患者死亡，并且与电子烟或雾化有关的肺部损伤被认为是促成因素，但不是导致死亡的原因。解释与电子烟或电子烟相关的肺损伤是与严重的肺损伤以及体质和胃肠道症状相关的新兴疾病。认识的提高已导致鉴定出接受抗生素和类固醇治疗的患者的各种疾病严重程度。尽管有所改善，但在短期随访中，许多患者仍有残余异常。与电子烟或电子烟相关的肺损伤仍然是一种临床诊断，其症状与传染病和其他肺部疾病重叠。在继续了解这些患者的病因，最佳治疗方法和长期预后方面，保持对该疾病的高度怀疑很重要。资金Intermountain Healthcare。
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