Date Presented 03/26/20
The vaping epidemic continues to grow in the United States, reaching 2,000 cases, and is poorly understood. This poster will describe in a case-study format the efficacy of OT intervention for an adult patient with vaping-induced ARDS.
Primary Author and Speaker: Malachy Clancy
Additional Authors and Speakers: Sara Steinagel, Fiona Egan
PURPOSE: The purpose of this case study is to demonstrate functional recovery and outcomes of Occupational Therapy evaluation and intervention for a patient with vaping induced Acute Respiratory Distress Syndrome (ARDS). The use of e-cigarettes has increased rapidly in the United States, with the Centers for Disease Control and Prevention reporting in late August 2019 that at least 215 acute, severe respiratory distress cases have been identified, spanning 25 states, with at least two deaths occurring (Christiani, 2019). This growing epidemic presents a unique and evolving need for Occupational Therapists to provide skilled intervention in this growing patient population.
DESIGN: We present a naturalistic observation of a 19-year-old male admitted with only a past medical history of asthma who presented to his primary care physician with cough and fevers. He had a chest x-ray concerning for pneumomediastinum, requiring hospital admission. He quickly developed increasing shortness of breath with worsening hypoxemia. Hemodynamically deteriorating, he was intubated and placed on venous-venous (VV) extracorporeal membranous oxygenation (ECMO) and was transferred to our 750 bed urban academic medical center for further management and consideration for lung transplant.
METHOD: The patient received 16 occupational therapy treatment sessions over his 60-day hospitalization (12 sessions in the ICU and 4 sessions on the surgical step down unit). The Assessment Measure for Post-Acute Care (AMPAC) “6-Clicks”, was utilized to evaluate the patient’s functional progression. The AMPAC “6-Clicks” has demonstrated high internal consistency reliability and validity, allowing efficiency, uniformity and accuracy in determining a patients’ activity limitations among the acute care setting (Jette et al, 2014). The Hospital Anxiety and Depression Scale (HADS) was utilized to assess the patient depression and anxiety throughout hospitalization.
RESULTS: The patient demonstrated functional recovery and near independence in all areas of occupations. Baseline AMPAC scores improved from 14 to 20 (increase of 6 points). Throughout treatment, barriers to functional recovery and intervention included pain, anxiety, and hemodynamic stability.
CONCLUSION: Occupational Therapy intervention was able to be safely implemented in this unique patient case through multidisciplinary collaboration. The patient experienced functional recovery and was able to be safely discharged home following a 60-day hospitalization.
IMPACT STATEMENT: The presentation will support OT intervention in the rehabilitation of this unique, emerging patient population, demonstrating distinct value in the recovery process of patients with vaping-induced ARDS.
References
Christiani, D. C. (2019). Vaping induced lung injury. New England Journal of Medicine. DOI: 10.1056/NEJMe1912032
2. Jette, D., Stiphen, M., Ranganathan, V., Passek, S., Frost, S, & Jette, A. (2014). Validity of the AM-PAC “6-Clicks” Inpatient Daily Activity and Basic Mobility Short Forms. Physical Therapy, 94(1), 379–391. doi.org/10.2522/ptj.20130199
