The death of a man after pulmonary insufficiency related to vaping

In a few days, passionate about hiking for 20 years, Alexander Mitchell had become alive thanks to two machines that forced him to come in and out of his lungs and oxygenate his blood at the same time. 39, outside his body.

"He went from sick to death almost literally in two days," recalls his father, Daniel Mitchell, who was striving to grasp the unthinkable. "The doctor said that he was dying.In all honesty, I was preparing to plan a funeral for my child.I cried and cried for this boy."

Alexander Mitchell's doctors in a hospital in Payson, Utah, were confused by the negative result of bacterial pneumonia tests and many common ailments. An examination, however, has highlighted something unusual – signs of abnormal immune cells in his lungs – usually associated with rare, life-threatening pneumonia observed in elderly people who accidentally inhale droplets from laxatives oil-based such as mineral oil.

The intuition of a doctor would help save Mitchell's life. The young man's lungs were failing – he was suffering from an acute respiratory distress syndrome, a life-threatening and often fatal lung injury. The doctor told the family that he suspected the illness was related to a vaping after hearing about similar cases elsewhere. The man from Provo, Utah, and his parents had mentioned that he was using electronic cigarettes. But until then, nobody had connected the dots. The doctors transported him to the University of Utah hospital in Salt Lake City, 65 miles away, to treat him so that he could maintain the oxygen that sinks and allow his lungs to heal.

The case of Mitchell is one of the most serious cases that doctors have observed among the vaping-related lung diseases that are currently under investigation by state and federal health officials – at least 193 cases in 22 states, many involving adolescents and young adults. On Friday, Illinois health officials announced the first known death of a lung disease related to vaping in an adult. They refused to provide more details. Meanwhile, state health services report an increasing number of cases.

There are more questions than answers about lung diseases and their link to devices that have gained popularity, despite little research on their long-term effects. Electronic cigarettes have been introduced to help smokers quit by satisfying their nicotine cravings without enlightening, but their use is now at an epidemic level among adolescents and young adults.

Those who became ill sprayed on various substances, including nicotine, marijuana-based products, and do-it-yourself crafts at different times and in different locations. Although the cases seem similar, the Centers for Disease Control and Prevention officials warn that they do not know if the diseases are associated with the electronic cigarette devices themselves or specific ingredients or contaminants that inhale them. It is not even clear that they have a common cause or it can be different diseases with similar symptoms.

The severity of some illnesses in previously healthy youth has puzzled family members and even some doctors.

"Seeing patients as sick is extremely alarming," said Sean Callahan, a pulmonologist at the University of Utah.

Alexander Mitchell thought that he had the flu when he woke up earlier this summer, suffering from nausea, chest pain and breathing difficulties. But he deteriorated so quickly that his parents, and even the doctors, were astonished.

For her parents, the scariest moment may have happened when doctors said that their son's lung failure required another aggressive life-sustaining device called ECMO. The machine pumps blood from the patient's body into an artificial lung that adds oxygen and removes carbon dioxide, thus replacing the function of one's own lungs. The machine then returns the blood to the patient.

"He had two tubes coming out of him, one was dark crimson red and the other was bright red," Daniel Mitchell recalled. "The doctors said that one-third of his blood was out of his system at a time."

If Alexander released his tubes, they would warn his parents: "He would be dead in 30 seconds and we could not do anything".

Doctors told parents that he might need a lung transplant if he showed no improvement. But after about nine days, the CPRs allowed her lungs to heal. He was able to return home on 7 July.

The University of Utah's doctors who saw Mitchell, in addition to four similar cases this summer, have their own theory on what could be causing the diseases associated with vaporization.

They say that one of the culprits can be the liquid, commonly known as vape juice, which is a component of all electronic cigarettes. The products vary widely, but they all contain a heating element that produces an aerosol from a liquid that users inhale via a mouthpiece.

The increase in the number of cases may be the result of something recently added to oils "to dilute or add them," said Scott Aberegg, a pulmonologist and specialist in intensive care at the hospital. from Utah, who treated Mitchell and four other patients from his hospital. and consulted on two others in another establishment.

Some of the patients had been volatilized for months and years, he said. Therefore, if there had ever been a group of cases, "we would have recognized it earlier".

However, tracing the vaping liquid back to where it was purchased was difficult in some cases. Some patients reported purchasing cartridges containing ingredients in other states. A patient told the doctors that he had received his cartridges in Las Vegas and that it seemed like they had been opened, probably to introduce THC, the main ingredient that produces the effects psychotropic marijuana, explained Aberegg. THC is not legal in Utah.

The spray liquid may contain nicotine, flavors, propylene glycol, vegetable glycerin and other ingredients, according to the Food and Drug Administration, which regulates tobacco products, including electronic cigarettes.

When the liquid is heated, the resulting aerosol can contain fine and ultrafine toxic particles, including heavy metals, flavoring chemicals, such as diacetyl, associated with a serious lung disease called "popcorn lung" and volatile organic compounds that can have long-term health effects, including cancer, according to a 2016 report by the American surgeon general.

"We do not know if it is propylene glycol or glycerine or other additives contained in the vaping liquids put in place by the manufacturers, or those products associated with the 39, other adulterating substances, manufacture after manufacture, when people add them or mix them up, "said Aberegg. .

Some of Utah's patients had less severe illnesses than Mitchell's. But four of the five also had abnormal immune cells in their lung samples, said Aberegg. Such cells are indicators of a variety of diseases, including a rare disease called lipoid pneumonia, whose symptoms include chest pain and difficulty breathing, similar to the symptoms of bacterial pneumonia.

Aberegg warned that there remains much unknown about the causes of abnormal immune cells in people with vaping-related illness.

But "in many cases, we are convinced that we are not just dealing with association, but with vaping and everything in the products," said Aberegg. Abnormal cells may be a "very important marker of vaping-related pneumonia" and "an important clue to what's going on".

Six weeks after leaving the hospital, Mitchell resumed the hike. But with a lung capacity decreased by 25%, he does not leave long or as often as before. He also struggles with his short-term memory. Doctors say that they are not sure that he will recover completely.

Doctors say that his youth was a crucial factor in his survival. "He was young, healthy and in good physical condition before the onset of the disease," said Aberegg, one of 20 clinicians who treated the young man.

Mitchell said that he had little recollection of what had happened while he was in the hospital since he was in a coma for medical reasons for the most part time. But he is amazed that doctors attribute his imminent death experience to vaping – a practice he began about two years ago because he wanted to quit conventional cigarettes.

"They say it's healthier," he said.

Above all, he said he sprayed flavored nicotine products, but used THC a few times with friends, he said. None of them got sick.

By mid-June, Mitchell had purchased a different brand of vape juice – minty peach flavored – at his usual vape shop and had used it with his same electronic cigarette machine. It was the first time that he was using a well-known brand. The family did not want to identify him until the FDA continued his investigations. "It was a brand new box," recalls Mitchell. Inside, "the bottle had a seal".

He said that he was calming less than usual this time around. The next day, he felt sick and began his medical odyssey that will change his life.

Adults can make decisions for themselves, Mitchell said. But he said his experience should be a warning about the dangers that are not clearly explained about vaping.

"I did not think it would literally take me to my deathbed," he said.

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Alice Crites from the Washington Post contributed to this report.