Chemical pleurodesis and somatostatin in treating spontaneous chylothorax in pediatric patients: a retrospective analysis and review of the literature

Long, Weiguang; Cai, Bin; Deng, Jian-Ming; Liu, Yang; Wang, Wenjie; Luo, Juan

doi:10.21037/tp-20-199

Cited by 7 publications

(10 citation statements)

References 29 publications

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“…For non-traumatic cases, conservative management including drainage, total parenteral nutrition, medium-chain fatty acid diet, and fasting are effective[ 4 ]. Somatostatin or octreotide is used for congenital chylothorax in child patient most to reduce lipid absorption, which was reported effective[ 21 , 22 ]. However, its dose and course are not well established.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax following posterior low lumbar fusion surgery: A case report

Huang¹,

Luo²,

Ran³

et al. 2021

WJCC

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BACKGROUND Postoperative chylothorax is usually regarded as a complication associated with cardiothoracic surgery; however, it is one of the rare complications in orthopedic surgery. This case report describes a female patient who developed chylothorax after a successful L4-S1 transforaminal lumbar interbody fusion surgery. The etiology, diagnosis, and treatment were analyzed and discussed. CASE SUMMARY A 50-year-old woman was admitted with repeated back and leg pain. She was diagnosed with L4 degenerative spondylolisthesis, L4/L5 and L5/S1 intervertebral disc herniation and L5 instability, and underwent successful posterior L4-S1 instrumentation and fusion surgery. Unfortunately, thoracic effusion was identified 2 d after operation. The thoracic effusion was finally confirmed to be chylous based on twice positive chyle qualitative tests. The patient was discharged after 12-d persisting drainage, 3-d total parenteral nutrition and fasting, and other supportive treatments. No recurring symptoms were observed within 12 mo follow-up. CONCLUSION Differential diagnosis is crucial for unusual thoracic effusion. Comprehensive diagnosis and treatment of chylothorax are necessary. Thorough intraoperative protection to relieve high thoracic pressure caused by the prone position is important.

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Section: Discussionmentioning

confidence: 99%

Chylothorax following posterior low lumbar fusion surgery: A case report

Huang¹,

Luo²,

Ran³

et al. 2021

WJCC

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“…Pleurodesis aims to obliterate the pleural space by instilling an irritating chemical or biological agent that induces inflammation 23,89,90 . Some of the agents used in neonates are talc, povidone‐iodine, tetracycline derivatives, fibrin glue, hypertonic glucose, and Streptococcus pyogenes A3 (OK‐432) 89–92 . Povidone‐iodine pleurodesis is safe, effective, and minimally invasive, with a high success rate and few complications.…”

Section: Methodsmentioning

confidence: 99%

“…Povidone‐iodine pleurodesis is safe, effective, and minimally invasive, with a high success rate and few complications. Side effects include allergic reactions, cardiopulmonary failure, thyrotoxicosis, and nephrotoxicity 90–95 . Use of fibrin glue has been described in neonatal patients, but is mainly associated with persistent pneumothorax 96,97 .…”

Section: Methodsmentioning

confidence: 99%

Chylothorax in the neonate—A stepwise approach algorithm

Rocha

Arnet

Soares

et al. 2021

Pediatric Pulmonology

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Background Chylothorax in neonates results from leakage of lymph from thoracic lymphatic ducts and is mainly congenital or posttraumatic. The clinical course of the effusion is heterogeneous, and consensus on treatment, timing, and modalities of measures has not yet been established. This review aims to present, along with levels of evidence and recommendation grades, all current therapeutic possibilities for the treatment of chylothorax in neonates. Methods An extensive search of publications between 1970 and 2020 was performed in the PubMed, Cochrane Database of Systematic Reviews, and UpToDate databases. A stepwise approach algorithm was proposed for both congenital and traumatic conditions to guide the clinician in a rational and systematic way for approaching the treatment of neonates with chylothorax. Discussion and Conclusion The treatment strategy for neonatal chylothorax generally involves supportive care and includes drainage and procedures to reduce chyle flow. A stepwise approach starting with the least invasive method is advocated. Progression in the invasiveness of treatment options is determined by the response to previous treatments. A practical stepwise approach algorithm is proposed for both, congenital and traumatic chylothoraces.

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“…Что касается детей, существует лишь несколько сообщений, в которых представлены небольшие по наполнению больными се-рии лечения пациентов, которым применяли повидон-йод по поводу хилоторакса [1,6,7,11,15,38,39,40]. В этих исследованиях концентрация раствора повидон-йода значительно отличалась, составляя от 2 до 10 %.…”

Section: дискуссияunclassified

“…Хилоторакс часто сочетается с преждевременными родами, низким весом при рождении, отеком плода, гипоплазией легких [2][3][4][5]. Летальность, связанная с этим заболеванием, может достигать 60 % [6].…”

Section: Introductionunclassified

Chemical pleurodesis using povidon-iodine for chylothorax treatment in newborns

Kozlov

Андреевич²,

Распутин

et al. 2020

Russian Journal of Pediatric Surgery, Anesthesia and Intensive

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Introduction. Chylothorax is a rare condition that results from abnormal accumulation of lymphatic fluid in the chest and one of the most common causes of pleural effusion in newborns. The aim of our study is to present our own experience of chemical pleurodesis using povidone-iodine in newborns with chylothorax. Materials and methods. In the present study, we studied data from 10 patients with chylothorax who, over the past years, starting in 2016, underwent chemical pleurodesis using the drug povidone-iodine. Congenital accumulation of lymph in the pleural cavity was recorded in 2 patients, acquired in 8 patients. The indications for this procedure were the absence of response to total parenteral nutrition for at least 10 days and the appointment of octreotide at the maximum dosage. Pleurodesis consisted in the introduction into the pleural cavity of a 4% solution of povidone-iodine with a calculated dose of 1 ml/kg. The povidone-iodine solution was kept inside the pleural cavity for the next 4 hours. Results. Chemical pleurodesis was successfully applied in all 10 patients. In 8 patients, a single prescription of the drug was sufficient, and in 2 remaining patients, the pleurodesis session was repeated. After the procedure of chemical pleurodesis, 2 patients developed respiratory distress syndrome caused by massive atelectasis of the homolateral lung, which was confirmed by X-ray examination. These patients required mechanical ventilation for 24 and 48 hours. The average time for the disappearance of chylothorax was 4 days. In the long-term follow-up, 1 patient died from progressive deterioration of pulmonary function against the background of lung hypoplasia. Conclusions. Our data demonstrate that povidone iodine pleurodesis is a effective treatment for chylothorax in newborns.

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Chemical pleurodesis and somatostatin in treating spontaneous chylothorax in pediatric patients: a retrospective analysis and review of the literature

Cited by 7 publications

References 29 publications

Chylothorax following posterior low lumbar fusion surgery: A case report

Chylothorax following posterior low lumbar fusion surgery: A case report

Chylothorax in the neonate—A stepwise approach algorithm

Chemical pleurodesis using povidon-iodine for chylothorax treatment in newborns

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