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A protocol to decrease postoperative chylous effusion duration in children

Melissa M Winder1, Aaron W Eckhauser2, Claudia Delgado-Corcoran3

  • 11Department of Pediatric Critical Care,Primary Children's Hospital,Salt Lake City,UT,USA.

Cardiology in the Young
|April 26, 2018
PubMed

Insights

Implementing a new management protocol significantly reduced chest tube use for pediatric patients with postoperative chylothorax. This quality improvement initiative shortened treatment duration and improved patient outcomes.

Area of Science:

  • Pediatric Cardiac Surgery
  • Thoracic Surgery
  • Quality Improvement Initiatives

Background:

  • Postoperative chylothorax is a known complication following pediatric cardiac surgery.
  • Variability in management can lead to prolonged treatment and increased resource utilization.

Purpose of the Study:

  • To decrease the time to resolution of postoperative chylothorax in pediatric patients.
  • To reduce the duration of chest tube utilization through a standardized management protocol.

Main Methods:

  • A quality improvement project implemented a chylothorax management protocol in July 2015.
  • Retrospective analysis compared pre-protocol (n=20) and post-protocol (n=22) cohorts of pediatric patients (0-17 years) undergoing cardiac surgery.
  • Data included chest tube duration, feeding strategies, and need for further interventions.

Main Results:

  • Total chest tube utilization decreased from 12 to 7 days (p=0.047).
  • Maximum chest tube duration reduced from 44 to 13 days.
  • Medium-chain triglyceride feed duration decreased from 42 to 31 days (p=0.01).

Conclusions:

  • A chylothorax management protocol is feasible and effective in pediatric cardiac surgery.
  • Protocol implementation significantly decreased chest tube utilization and practice variability.
  • The protocol led to shorter treatment durations without impacting ventilation or length of stay.
Abstract

Keywords:
Paediatricschylothoraxclinical protocolsheart defectsquality improvement

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