A protocol to decrease postoperative chylous effusion duration in children

Winder, Melissa; Eckhauser, Aaron; Delgado-Corcoran, Claudia; Smout, Randall J.; Marietta, Jennifer; Bailly, David K.

doi:10.1017/s1047951118000392

Cited by 18 publications

(25 citation statements)

References 18 publications

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“…MCT and 9 days in TPN (P > .05), which was similar to reports by Yeh et al [2013] and Winder et al [2018]. The length of hospital stay was significantly shorter in the EN with MCT group, partly because of the shorter time of chest tube utilization.…”

Section: E906supporting

confidence: 87%

“…The nutrition support costs in the EN with MCT group were lower than in the TPN group (P = .000), but the difference in total costs during hospitalization was not significant. Chylothorax has been diagnosed a median of 4 to 9 days after surgery [Chan 2010;Chan 2006;Winder 2018;Yeh 2013]; in our study, it 6 days in both groups. The length of PICU stay was a median of 8 days in EN with…”

Section: Discussionsupporting

confidence: 46%

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Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children

Zheng

Chen

Zhang

et al. 2020

HSF

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Background: Chylothorax is caused by thoracic lymphatic system injury that leads to lymph extravasates in the thoracic cavity. Cardiac surgery was the most common cause. Reports comparing therapeutic effects between enteral nutrition (EN) with medium-chain triglycerides (MCT) and total parenteral nutrition (TPN) are few and inconsistent. Our study aimed to analyze the incidence of chylothorax in children in our hospital and optimum nutritional management modalities. Methods: We retrospectively reviewed the medical records of children admitted to our hospital with a diagnosis of chylothorax from 2014 to 2018. We analyzed the incidence of chylothorax, therapeutic effectiveness, and cost effectiveness of EN with MCT or TPN. Results: 136 patients with chylothorax after surgery for congenital heart disease (CHD) were identified from 172 patients with chylothorax (79.07%); chylothorax occurred in 5.62% of all 2420 congenital heart disease surgeries that were performed during that period. Tetralogy of Fallot (TOF), ventricular septal defect (VSD), and double-outlet right ventricle (DORV) were the most common primary diagnoses. Fontan surgery, TOF repair, and VSD repair were the most common primary procedures. We enrolled 45 patients with cured chylothorax. Nutrition support costs in the EN with MCT group (n = 28) were significantly lower than in the TPN group (n = 17) (P = .000). Time to resolution and time to removal of the drainage tube were shorter in EN with MCT versus TPN (P = .003), and the length of hospital stay was shorter (P = .032). There were no significant differences between the 2 groups in time from admission to surgery, postoperative days before diagnosing chylothorax, or length of PICU stay (P > .05). Conclusions: The therapeutic effects of EN with MCT were significantly better than those of TPN, with lower costs. Therefore, we suggest that EN with MCT be chosen first to treat chylothorax caused by surgery with mild chest drainage volume when gastrointestinal tract function is allowed.

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Section: E906supporting

confidence: 87%

Section: Discussionsupporting

confidence: 46%

Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children

Zheng

Chen

Zhang

et al. 2020

HSF

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“…Protocol-based management has been proposed to improve the outcomes of chylothorax, and studies have shown that implementing such management strategies led to reductions in chest tube utilization time and improvements in clinical outcomes [12][13][14]. We developed a management protocol and implemented it in September 2014.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax after Surgery for Congenital Cardiac Disease: A Prevention and Management Protocol

Shin

Lee

Park

et al. 2020

Korean J Thorac Cardiovasc Surg

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This article was presented at the 50th Annual Meeting of the Korean Society for Thoracic and Cardiovascular Surgery. Background: Chylothorax after congenital heart surgery is not an uncommon complication, and it is associated with significant morbidity. However, consensus treatment guidelines are lacking. To improve the treatment outcomes of patients with postoperative chylothorax, we implemented a standardized management protocol at Severance Hospital in September 2014. Methods: A retrospective review of patients treated at a single center was done. All corrective and palliative operations for congenital heart disease performed at our institution between January 2008 and April 2018 were reviewed. The incidence and treatment outcomes of postoperative chylothorax were analyzed. Results: The incidence of chylothorax was 1.9%. Sixty-one percent of the patients could be managed with a low-fat diet, while 28% of the patients required complete restriction of enteral feeding. Thoracic duct embolization was performed in 2 patients and chest tube drainage decreased immediately after the procedure. No patient required thoracic duct ligation or pleurodesis. After implementation of the institutional management protocol, the number of chest tube drainage days decreased (median, 24 vs. 14 days; p=0.45). Conclusion: Implementing a strategy to reduce postoperative chylothorax resulted in an acceptable incidence of postoperative chylothorax. Instituting a clinical practice protocol helped to curtail the treatment duration and to decrease the requirement for surgical treatment. Image-guided embolization of the thoracic duct is an effective treatment for postoperative chylothorax.

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“…It is quite a liberal manner to step “back and forth” on the intensity of fat restriction without using a standard fixed protocol. Strategies that have been successful in shortening time to resolution of chylothorax and chest tube utilization in the pediatric population are specific steroids (hydrocortisone, dexamethasone, and methylprednisolone) and furosemide ( 14 ), thoracic duct embolization ( 9 , 15 , 16 ) and protocolized management ( 9 , 17 ). Most protocols categorized the severity of chylothorax by the volume of chyle output, using a cut-off of 20 mL/kg/day.…”

Section: Discussionmentioning

confidence: 99%

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute

Ruangnapa¹,

Anuntaseree²,

Saelim³

et al. 2022

J Thorac Dis

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Background: Chylothorax is an uncommon cause of pleural effusion in children. This study aimed to determine the characteristics, treatment strategies, and outcomes of chylothorax in children from a single institute. Methods:The 65 episodes of chylothorax in patients aged 0-15 years who were diagnosed and received treatment in Songklanagarind Hospital between January 2001 and December 2020 were retrospectively review and analyzed.Results: Of the 65 episodes, 80% were postoperative chylothorax, and were mostly related to cardiac surgery. The most common treatment strategy employed was dietary modification (64.6%). Octreotide was used as adjunctive therapy in 33.8%. Most cases of chylothorax were successfully treated by conservative treatment, while 10.7% required surgical therapy. The median time to resolution of chylothorax was 21 days [interquartile range (IQR): 8-33 days]. Young children aged <1 year were more likely to require mechanical ventilation and develop ventilator-associated pneumonia and catheter-related complications. The factors associated with death or prolonged hospitalization (>28 days) were non-postoperative chylothorax, use of total parental nutrition (TPN) >14 days, hypoalbuminemia, and ventilator-associated pneumonia.Conclusions: Most (89.2%) cases of chylothorax were successfully treated conservatively using dietary modification and octreotide therapy. The modifiable risk factors for death or prolonged hospitalization were use of TPN >14 days and hypoalbuminemia.

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A protocol to decrease postoperative chylous effusion duration in children

Abstract: Adoption of a chylothorax management protocol is feasible, and in our small cohort of patients implementation led to a significant decrease in the duration of chest tube utilisation, while eliminating practice variability among providers.

Cited by 18 publications

References 18 publications

Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children

Incidence and Nutritional Management of Chylothorax after Surgery for Congenital Heart Diseases in Children

Chylothorax after Surgery for Congenital Cardiac Disease: A Prevention and Management Protocol

Treatment and outcomes of chylothorax in children: 20-year experience of a single institute

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