Summary
Introduction:
This text provides a comprehensive summary of a systematic review conducted to examine the pulmonary effects of electronic vapor delivery systems (EVDS), commonly known as vaping. The review aims to support future anesthetic guidelines for patients who vape by identifying how EVDS use affects the pulmonary system.
Key Points:
* The review included 38 studies that described the effects of EVDS on pulmonary function, airway epithelial tissue, and inflammatory mechanisms that may lead to chronic pulmonary disease.
* Exposure to EVDS can lead to alterations in pulmonary function tests, disrupted ventilation, impaired mucociliary clearance, tissue destruction, a disrupted immune response, and oxidative stress with DNa fragmentation.
* Six studies found that EVDS use caused a significant decrease in FeNO, an inflammatory marker, suggesting an acute narrowing of the airways. however, other studies found an acute increase in FeNO, indicating inflammation.
* Three studies found that vaping a PG/VG aerosol mixture caused a significant decrease in arterial oxygen tension, oxyhemoglobin fraction, and transcutaneous oxygen tension levels, indicating an acute disruption in pulmonary gas exchange caused by small airway constriction.
* Four studies identified a relationship between fractional exhaled nitric oxide (FeNO) and EVDS use, suggesting that vaping may be more detrimental in those with preexisting lung disease.
* Seven articles examined the effects of EVDS on mucociliary clearance and found that exposure to EVDS vapor led to an increase in mucus production and changes to bronchial epithelial cilia.
* Four studies found that EVDS use was associated with pulmonary tissue destruction, including the stimulation of neutrophils to release neutrophil elastase (NE) and matrix metalloproteinase (MMP), which are proteases responsible for tissue breakdown.
* Nine studies identified the potential for EVDS vapor to induce an impaired immune response, including the presence of lipid-laden macrophages and pro-inflammatory cytokines.
Main Message:
The systematic review identified six EVDS-induced pulmonary implications warranting anesthetic consideration: alterations in pulmonary function tests, disrupted ventilation, impaired mucociliary clearance, tissue destruction, a disrupted immune response, and oxidative stress with DNa fragmentation. anesthesia providers are encouraged to assess patients for EVDS use during the preoperative period and use the information generated by this systematic review to drive subsequent care. The review highlights the need for further research to guide anesthetic management strategies for patients who vape.
Citation
Novelli CE, higginbotham EJ, Kapanke Ka, Webber-Ritchey KJ, Parker Ch, Simonovich SD. a systematic review examining the pulmonary effects of electronic vapor delivery systems. Journal of clinical anesthesia. 2022;82:110952. doi:10.1016/j.jclinane.2022.110952
