Recommendations for Discharging Patients With Vaping-Related Lung Injury

New findings on vaping-related rehospitalizations and deaths have prompted the Centers for Disease Control and Prevention (CDC) to develop recommendations for outpatient follow-up during the first 48 hours post-hospitalization. According to the CDC’s Morbidity and Mortality Weekly Report, at least one quarter of e-cigarette or vaping product use–associated lung injury (EVALI) patients were rehospitalized or died within two days of discharge. The organization says this new guidance can help healthcare systems to better manage hospitalized EVALI patients, which could reduce their post-discharge morbidity and mortality.  

As outlined by the CDC, hospitals are advised to:

1. confirm no clinically significant fluctuations in vital signs for at least 24–48 hours before discharge;
2. ensure outpatient primary care or pulmonary specialist follow-up, optimally within 48 hours of discharge (previously recommended within 2 weeks of discharge). This should include:
   1. clinical assessment for stable vital signs, physical exam, resolution or symptoms and normalized laboratory tests;
   2. education about EVALI;
   3. confirmation of medication adherence, specifically with regimens such as tapering of corticosteroids (if prescribed at the time of hospital discharge);
   4. reinforcement of the importance of abstinence from e-cigarette, or vaping, product use;
   5. facilitation of a connection to outpatient care by all providers or services indicated by patients’ medical history or conditions;
   6. facilitation of a connection to necessary social, mental health and substance use disorder resources; and
   7. establishment of a connection to necessary services.
3. plan for discharge care, early follow-up and management of any comorbidities;
4. arrange posthospitalization specialty care;
5. follow best practices for medication adherence; and
6. ensure social support and access to mental and behavioral health and substance use disorder services.

According to the CDC report, these updates build on previous EVALI guidance which focuses on:  

1. “diagnosis (including obtaining an accurate history and conducting a physical examination that includes vital signs, pulmonary auscultation, and pulse oximetry; laboratory testing to rule out infectious etiologies; radiographic imaging; and consulting a specialist);
2. inpatient and outpatient management (including consideration of empiric administration of corticosteroids and antimicrobials, if indicated);
3. follow-up after hospital admission; and
4. considerations during the influenza season.”

Click here to view the complete CDC report.

MLMIC encourages all our insured healthcare providers to continue educating themselves regarding the evolving clinical guidance available to them to treat lung injuries from vaping products. Ensuring a smooth transition in care at hospital discharge and prompt out-patient follow-up is pivotal in preventing rehospitalization and even death.