1. Huey, Sally DNP, FNP-BC
  2. Granitto, Margaret ANP-BC, CNL

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I'm caring for a teenage girl who is recovering from a serious lung injury related to vaping. What discharge planning and teaching needs should I consider?-A.I., LA.


Sally Huey, DNP, FNP-BC, and Margaret Granitto, ANP-BC, CNL, reply: Acute lung injury linked to vaping has been termed electronic cigarette and vaping associated lung injury (EVALI). As of February 2020, over 2,800 people had been hospitalized with EVALI and 68 deaths had been reported to the CDC. The median patient age was 24.1


E-cigarettes work by heating a liquid that usually contains nicotine and various chemical components to form an aerosol that is inhaled deep into the lungs.2 However, modification of available hardware for vaping has allowed users to vape tetrahydrocannabinol (THC) or cannabinoid oils as well.


Although the exact cause of EVALI is unknown, the CDC reports that vaping products containing THC are linked to most EVALI cases. In addition, vitamin E acetate found in products containing THC is strongly implicated.1 Research is ongoing.


For clinicians caring for patients with EVALI, the CDC has issued an EVALI discharge readiness checklist.3 This practical tool is intended to help clinicians determine that a patient is ready for discharge and ensure appropriate outpatient follow-up. It covers these points:


* The patient must be clinically stable to be discharged from the hospital. This includes normalization of lab values and stable vital signs, physical assessment findings, and oxygenation and exercise tolerance for 24 to 48 hours before discharge.


* Initial outpatient follow-up with a primary care provider should be scheduled within 48 hours of discharge. Follow-up with a pulmonologist should occur in 2 to 4 weeks, with a second appointment within 2 months after discharge.


* The guidelines also provide specific recommendations for certain patient groups. For example, because pediatric patients who were treated with a corticosteroid are at increased risk for adrenal crisis, they should be educated about signs and symptoms of adrenal insufficiency and follow up with an endocrinologist.


* All patients should be evaluated for outpatient resources such as physical therapy, mental health services, and substance abuse services. When indicated, these resources should be arranged before discharge.



Besides medication reconciliation, patient teaching, and other standard discharge responsibilities, the CDC urges clinicians to conduct substance use disorder screening and offer cessation support. This includes discussing cessation of e-cigarette use, documenting a quit plan, and offering evidence-based tobacco product cessation interventions such as behavioral counseling and medications.


Access the CDC's EVALI discharge checklist at




1. Centers for Disease Control and Prevention. Outbreak of lung injury associated with the use of e-cigarette, or vaping, products. 2020. [Context Link]


2. Clark JS. Vaping: cleaner nicotine or a new toxic epidemic? UT Southwestern Medical Center. 2019. [Context Link]


3. Centers for Disease Control and Prevention. EVALI discharge readiness checklist. 2019. [Context Link]