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A defined management strategy improves early outcomes after the Fontan procedure: the PORTLAND protocol
Rachel E Sunstrom1, Ashok Muralidaran1, Rabin Gerrah1
1Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
The Annals of Thoracic Surgery
|December 3, 2014
Summary
The PORTLAND protocol significantly reduced chest tube drainage and hospital stay for Fontan procedure patients. This management strategy improved early outcomes, decreasing intensive care unit and overall hospital length of stay.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Fontan procedure patients often experience prolonged hospital stays.
- Chest tube drainage is a significant factor contributing to extended recovery.
- Optimizing postoperative management is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of the PORTLAND protocol in reducing chest tube drainage.
- To assess the impact of the PORTLAND protocol on hospital length of stay post-Fontan procedure.
Main Methods:
- Retrospective analysis of 42 Fontan procedure patients (June 2008-September 2013).
- Comparison between patients managed before (Group A, n=28) and after (Group B, n=14) the PORTLAND protocol implementation.
- The PORTLAND protocol includes: Peripheral vasodilation, Oxygen, fluid Restriction, surgical Technique, Low-fat diet, Anticoagulation, No ventilator, and Diuretics.
Main Results:
- Group B showed significantly lower median chest tube days (6 vs 11) and total indexed drainage (126 vs 259 mL/kg).
- Patients on the PORTLAND protocol had shorter intensive care unit (4 vs 7 days) and hospital stays (8 vs 13 days).
- Group B exhibited higher preoperative common atrial and end-diastolic pressures, with a trend towards higher pulmonary artery pressures.
Conclusions:
- The PORTLAND protocol demonstrates efficacy in improving early outcomes following the Fontan procedure.
- Implementation of the PORTLAND protocol led to reductions in chest tube drainage duration and overall length of hospital stay.
- The protocol offers a valuable management strategy for Fontan patients.
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