Diagnosis and Acute Management of E-cigarette or Vaping Product Use- Associated Lung Injury (EVALI) in the Pediatric Population: A Systematic Review

Clarelle L Gonsalves, Jie Wei Zhu, April J Kam
Journal of Pediatrics 2020 September 19

OBJECTIVES: To assess quantitative data on the presentation, investigative findings, patterns of lung injury, and interventions of pediatric cases of e-cigarette or vaping associated lung injury (EVALI) in the acute care setting.

STUDY DESIGN: A literature search using keywords was performed on April 17, 2020 in accordance with PRISMA guidelines. 3558 articles published were extracted from MEDLINE via PubMed, Embase via OVID, CINAHL via EBSCO, Web of Science and the Cochrane Library. Studies were evaluated for inclusion based on predetermined inclusion and exclusion criteria by two independent reviewers.

RESULTS: The search yielded a total of 3558 individual results, 145 of which were evaluated by full text review, resulting in 23 articles included in this systematic review. Two of these articles were identified by manual search of article references. A total of 61 cases of EVALI were described and 10 major patterns of lung injury were identified for which presenting symptoms, diagnostic and laboratory investigations, interventions, and outcomes were synthesized.

CONCLUSIONS: Cases of EVALI in the pediatric population have been reported in patients as young as 13 years of age and often present with respiratory, constitutional, abdominal, and cardiovascular signs and symptoms. Diagnostic findings vary based on underlying lung injury pattern. However, typical patterns of common findings were identified, including the presence of ground-glass opacities on computed-tomography (CT) and leukocytosis. Mainstays of treatment include the use of corticosteroids, antibiotics, and ventilatory support including extracorporeal membrane oxygenation (ECMO). Outcomes range from complete or near complete recovery of lung function to death.

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