Home Oxygen After Hospitalization for COVID-19: Results From the Multi-Center OXFORD Study.

BACKGROUND: In the first months of the pandemic, prior to the introduction of proven-effective treatments, 15-37% of patients hospitalized with COVID-19 were discharged on home oxygen. After proven-effective treatments for acute COVID-19 were established by evidence-based guidelines, little remains known about home oxygen requirements following hospitalization for COVID-19. METHODS: This was a retrospective, multi-center cohort study of subjects hospitalized for COVID-19 between October 2020-September 2021 at 3 academic health centers. Information was abstracted from electronic health records at the index hospitalization and for 60 d after discharge. The World Health Organization COVID-19 Clinical Progression Scale score was used to identify patients with severe COVID-19. RESULTS: Of 517 subjects (mean age 58 y, 47% female, 42% Black, 36% Hispanic, 22% with severe COVID-19), 81% were treated with systemic corticosteroids, 61% with remdesivir, and 2.5% with tocilizumab. About one quarter of subjects were discharged on home oxygen (26% [95% CI 22-29]). Older age (adjusted odds ratio [aOR] 1.02 per 5 y [95% CI 1.02-1.02]), higher body mass index (aOR 1.02 per kg/m2 [1.00-1.04]), diabetes (yes vs no, aOR 1.73 [1.46-2.02]), severe COVID-19 (vs moderate, aOR 3.19 [2.19-4.64]), and treatment with systemic corticosteroids (yes vs no, aOR 30.63 [4.51-208.17]) were associated with an increased odds of discharge on home oxygen. Comorbid hypertension (yes vs no, aOR 0.71 [0.66-0.77) was associated with a decreased odds of home oxygen. Within 60 d of hospital discharge, 50% had documentation of pulse oximetry; in this group, home oxygen was discontinued in 46%. CONCLUSIONS: About one in 4 subjects were prescribed home oxygen after hospitalization for COVID-19, even after guidelines established proven-effective treatments for acute illness. Evidence-based strategies to reduce the requirement for home oxygen in patients hospitalized for COVID-19 are needed.

A 20-year-old woman with rapidly progressive dyspnea and diffuse pulmonary infiltrates.

Silicone is a liquid polymer previously considered to be immunologically inert and favored in cosmetic procedures. Increasing evidence shows a multisystemic inflammatory reaction to its administration constituting the silicone embolism syndrome (SES). The majority of adverse effects are seen in the pulmonary system resulting in extensive diffuse alveolar damage and ultimately ARDS. Neurologic involvement occurs frequently and is uniformly fatal. Large volume injections, high pressure infiltrations and prior exposure to silicone have been implicated, with an IgG polydimethylsiloxane antibody described. Most patients meet Schonfield criteria for fat embolism syndrome and treatment is largely supportive. As the illicit use of injectable silicone rises worldwide, so does the incidence of related morbidities and fatalities, necessitating a high index of suspicion for SES in patients with neurologic or pulmonary symptoms and recent exposure to liquid silicone. We report an unusual case of multi-organ dysfunction following silicone injection.