Impact of Vaping on Hospital Outcomes in Patients With Acute Respiratory Distress Syndrome

Objective Introduced in the early 2000s, e-cigarettes and vaping have risen in popularity, leading to a notable increase in acute lung injury and the coining of electronic cigarette or vaping-associated lung injury (EVALI). Current studies have examined outcomes in EVALI specifically; however, data on the impact of vaping in acute respiratory distress syndrome (ARDS) is lacking. Thus, the objective of this study is to investigate the impact of vaping on hospital outcomes in patients with ARDS. Materials and methods This study is a retrospective chart review utilizing the Hospital Corporation of America (HCA) Healthcare Far West Division database. Unique patient encounters between January 1, 2016, and July 31, 2022, were included if they were associated with a diagnosis of acute respiratory distress syndrome (ARDS) and had documented vaping status. Pediatric patients under the age of 18 years were excluded. Due to the retrospective nature of the study, no interventions were performed. Outcomes were stratified and compared based on vaping status. Demographics and comorbidities were controlled for in the analysis. Measurements Patient demographics and medical comorbidities were extracted and analyzed. Key hospital outcomes of interest include use of non-invasive positive pressure ventilation (NIPPV), use of mechanical ventilation, hospital and intensive care unit (ICU) length of stay (LOS), and mortality. Statistical analysis of comorbidities was performed using chi-square analyses and Fisher's exact test between the two groups. Multinomial logistic regression was used to analyze the type of respiratory support required, while negative binomial regression was used to analyze hospital and ICU length of stay. Binary logistical regression with Firth correction was used to analyze differences in mortality. Statistical significance for all analyses was defined as a p-value of less than 0.05. Odds ratios were calculated with a 95% confidence interval. All analyses controlled for age, BMI, sex, medical comorbidities, and smoking status. Results A total of 269 patients were identified, of whom 42 vaped. Statistical analysis revealed no significant differences in demographics between those who vaped and those who did not. Fifty-seven patients required NIPPV, of whom 12 vaped. Eighty patients required mechanical ventilation, of whom seven vaped. Binary logistic regression with a Firth correction revealed a statistically significant decrease in odds (odds ratio {OR}: 0.377; 95% CI: 0.145, 0.979; p=0.045) of requiring mechanical ventilation in patients who vaped compared to those who did not. There were 15 mortalities, of whom four vaped. Binary logistic regression did not reveal statistical significance in mortality. The average hospital length of stay was 8.94 days, and the average length of stay (ICU LOS) was 5.48 days. Negative binomial regression revealed no statistically significant difference in both hospital and ICU LOS between patients who vaped and those who did not. Conclusion While statistical analysis did reveal a significantly decreased odds ratio of requiring mechanical ventilation in patients who vaped, the power of this and other findings was low, given a sample size of 42 who vaped. Despite its limitations, the study shares some preliminary insight into vaping and ARDS for future studies.