Utility of a Clinical Practice Guideline in Treatment of Chylothorax in the Postoperative Congenital Heart Patient

Yeh, Jay; Brown, Erin R.; Kellogg, Kimberly; Donohue, Janet E.; Yu, Sunkyung; Gaies, Michael; Fifer, Carlen G.; Hirsch, Jennifer C.; Aiyagari, Ranjit

doi:10.1016/j.athoracsur.2013.05.058

Cited by 56 publications

(75 citation statements)

References 19 publications

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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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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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“…Since we knew that cavopulmonary anastomosis procedures have a higher risk for prolonged pleural drainage, a more aggressive therapy with early initiation might be indicated for these patients; [3] hence, the need for a standard treatment protocol for chylothorax is crucial. Yeh et al [11] formulated a chylothorax algorhythm treatment in 2013 that produced an early diagnosis which reduced the time in the hospital as well as the use of mechanical ventilation. Their patients were fed with medium chained fatty acids when the amount of drainage was <20 mL/kg/day, but the oral intake ceased when the amount of drainage was >20 mL/kg/day.…”

Section: Discussionmentioning

confidence: 99%

“…[10] The optimal management of chylothorax is unclear because no prospective studies exist to aide in the choice of therapy since different protocols and strategies are followed in each center. [11,12] The primary modes of treatment include pleural space evacuation, the use of MCT oil-based formulas, enteric rest, and parenteral alimentation, [12,13] and these have shown a success rate of 77% within a maximum of 45 days, with an average time of approximately 12 days. [14] Previous studies have suggested that persistent chylous output for more than three weeks and lesions associated with elevated systemic venous pressure were risk factors for the failure of conservative management options.…”

Section: Discussionmentioning

confidence: 99%

Chylothorax following pediatric cardiac surgery

Yıldız¹,

Öztürk²,

Altin³

et al. 2015

Turk Gogus Kalp Dama

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ÖZAmaç: Bu çalışmada şilotoraksın insidansı, tedavi protokolleri ve pediatrik kardiyovasküler cerrahi sonrası erken dönem bulgular üzerindeki etkisi değerlendirildi. Ça lış ma pla nı: Haziran 2011 -Haziran 2014 tarihleri arasında kliniğimizde kalp ameliyatı geçiren 1123 pediatrik hastanın kayıtları retrospektif olarak incelendi. Ameliyat sonrası şilotoraks gelişen 35 hasta (19 erkek, 16 kız; ortanca yaş 240 gün; dağılım 5 gün-15 yıl) çalışmaya dahil edildi. Bul gu lar: Şilotoraks gelişimi en sık tek ventrikül tamirlerinde saptandı (n=11, %31). Bunu aortik ark tamiri (n=9, %25), Fallot tetralojisi (n=4, %11) atriyoventriküler septal defekt tamirleri (n= 4, %11), arteriyel switch ameliyatları (n=3, %8), ventriküler septal defekt tamirleri (n=2, %6) ve diğer ameliyatlar (n=2, %6) izledi. Ortanca şilotoraks drenaj süresi dokuz gün (dağılım 2-44 gün) idi. Beslenme yönetimi yağdan fakir diyet, orta zincirli yağ asitlerinden zengin enteral beslenme ve total parenteral beslenmeyi içerdi. On dört hastaya oktreotid, dört hastaya duktus torasikus ligasyonu ve dört hastaya plörodezis uygulandı. Dokuz hastada sepsis gözlendi ve üç hasta kaybedildi. So nuç:Pediatrik kardiyak cerrahi sonrası gelişen şilotoraks nadir olmayan bir komplikasyondur. En sık tek ventrikül tamiri sonrasında gelişir ve ameliyat sonrası klinik seyir ve morbidite üzerinde anlamlı etkiye sahiptir.Anah tarsöz cük ler: Kardiyak cerrahi; çocuklar; şilotoraks. ABSTRACT Background:This study aims to evaluate the incidence, treatment protocols, and impact of chylothorax on early outcomes after pediatric cardiovascular surgery. Methods: Records of 1,123 pediatric patients who underwent heart operation at our clinic between June 2011 and June 2014 were reviewed retrospectively. Thirty-five patients (19 males, 16 females; median age 240 days; range 5 days to 15 years) who developed postoperative chylothorax were included in the study. Results: Development of chylothorax was detected most frequently in single ventricle repairs (n=11, 31%). It was followed by aortic arch repairs (n=9, 25%), tetralogy of Fallot (n=4, 1%), atrioventricular septal defect repairs (n=4, 11%), arterial switch operations (n=3, 8%), ventricular septal defect repairs (n=2, 6%), and other operations (n=2, 6%). Median duration of drainage of chylothorax was nine days (range, 2 to 44 days). Nutritional management included low lipid diet, enteral feedings enriched with mediumchain triglycerides, and total parenteral nutrition. Fourteen patients were administered octreotide, four patients were administered thoracic duct ligation, and four patients were administered pleurodesis. Sepsis was observed in nine patients and three patients died. Conclusion: Chylothorax developing after pediatric cardiac surgery is not a rare complication. It occurs most frequently after single ventricle repair and has a significant impact on postoperative clinical course and morbidity.

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“…Approximately 80% of pediatric patients respond to medical therapy, although octreotide therapy and TPN carry their own risks [1,13]. Recommendations vary regarding indications and timing for surgical management with thoracic duct ligation or pleurodesis, but cases are generally considered refractory when effusion persists for more than 2 weeks despite conservative management [14]. Overall, these surgical interventions have a high success rate, and the main risk factor for death or chylothorax recurrence after surgery is thrombosis of the upper body venous vessels [15], thus confirming the importance of relieving such an occlusion whenever possible.…”

Section: Discussionmentioning

confidence: 99%

Intravascular Stent Implantation as Effective Therapy for Refractory Chylothorax Secondary to Congenital Superior Vena Cava Stenosis in an Infant

Harrison¹,

Sullivan²,

Christman³

et al. 2017

jshd

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Chylothorax is a rare but dangerous cause of respiratory failure in the pediatric population. It most commonly presents after cardiac surgery or, alternatively, due to retrograde pressure on the thoracic duct from narrowing or obstruction in the innominate vein due to thrombus or neoplasm. We observed an unusual presentation of chylothorax in an otherwise healthy 3-month-old infant with congenital superior vena cava stenosis leading to acute respiratory collapse. After initially not responding to medical therapy, the patient was successfully treated with an intravascular stent.

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Utility of a Clinical Practice Guideline in Treatment of Chylothorax in the Postoperative Congenital Heart Patient

Cited by 56 publications

References 19 publications

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

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

Chylothorax following pediatric cardiac surgery

Intravascular Stent Implantation as Effective Therapy for Refractory Chylothorax Secondary to Congenital Superior Vena Cava Stenosis in an Infant

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