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

摘要

Study Population and SettingClinical Practice Guideline DevelopmentMeasurementsStatistical AnalysisLimitationsConclusionsReferencesChylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention.MethodsAfter institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n?= 118) and from June 2010 to August 2011 (late cohort; n?= 45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization.ResultsThere were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to?chylothorax diagnosis (9 in early cohort versus 6?days?in late cohort, p?= 0.004), ICU length of stay (18?vs?9 days, p?= 0.01), hospital length of stay (30 vs 23?days,?p?= 0.005), and total durations of mechanical?ventilation (11 vs 5 days, p?= 0.02), chest tube use (20 vs 14 days, p?=?0.01), central venous line use (27 vs 15 days, p?= 0.001), and NPO status (9.5 vs 6 days, p?=?0.04).ConclusionsInstitution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.CTSNet classification:18Abbreviations and Acronyms: BSI (bloodstream infections), CPG (clinical practice guideline), CVL (central venous line), EC (early cohort), ICU (intensive care unit), LC (late cohort), NPO (nil per os), RACHS-1 (Risk Adjustment for Congenital Heart Surgery), TPN (total parenteral nutrition)Chylothorax, the accumulation of lymphatic fluid within the pleural space, is a common complication after cardiothoracic surgery. Postoperative chylothorax is the most common cause of chylothorax in the pediatric population, exceeding congenital chylothorax and lymphatic malformations [