An international survey of the nutrition management of chylothorax: a time for change
L V Marino1,2,3,4, K L Bell5,6, J Woodgate6
1Department of Dietetics/SLT.
Insights
Management of chylothorax (chylothorax) after pediatric heart surgery varies globally. This survey reveals significant international differences in diet therapy duration and fat restriction, highlighting a need for standardized, evidence-based guidelines to improve patient outcomes.
Area of Science:
- Pediatric Cardiothoracic Surgery
- Critical Care Medicine
- Pediatric Gastroenterology
Background:
- Chylothorax is an infrequent but serious complication of pediatric cardiothoracic surgery.
- It is associated with increased morbidity, mortality, and healthcare costs.
- Current management lacks prospective evidence and consensus guidelines.
Purpose of the Study:
- To characterize international practice variations in chylothorax management.
- To identify areas for future research in chylothorax treatment.
Main Methods:
- A descriptive, international, observational survey was conducted.
- The survey targeted healthcare professionals in pediatric intensive care and cardiology units.
- It investigated clinical practices related to chylothorax, including diet composition and duration.
Main Results:
- Sixty-four professionals from 16 countries responded.
- Management approaches varied, with physician preference common in Australia/New Zealand and unit protocols elsewhere.
- Dietary fat restriction and therapy duration showed significant regional differences (e.g., <5g fat/day, 4-6 weeks duration).
Conclusions:
- Significant international variations exist in chylothorax management, especially regarding diet therapy duration and fat restriction.
- There is a critical need for multi-center randomized controlled trials to establish evidence-based practices.
- Standardized guidelines are essential to reduce morbidity, particularly poor growth, in pediatric patients with chylothorax.
Introduction:
Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim of this survey was to characterise variations in practice in the management of chylothorax and to identify areas for future research.
Materials And Methods:
A descriptive, observational survey investigating conservative management practices of chylothorax was distributed internationally to health-care professionals in paediatric intensive care and cardiology units. The survey investigated five domains: the first providing general information about health-care professionals and four domains focusing on clinical practice including diet composition and duration.
Results:
In total, sixty-four health-care professionals completed the survey, representing 38 organisations from 16 countries. The respondents were dietitians (80%), physicians (19%), and nurses (1%). In Australia and New Zealand, management was most commonly directed by physicians' preference (67%) as compared to unit protocols in Europe (67%), United States of America (67%), and Other regions (55%). Dietitians in Australia/New Zealand, United Kingdom, and Ireland followed the most restrictive diet therapy recommending <5 g long chain triglyceride fat per day (p < 0.00001). The duration of diet therapy significantly varied between regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4 weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6 weeks (75%) (p < 0.00001).
Conclusions:
This survey highlights international variations in practice in the management of chylothorax, particularly with respect to treatment duration and dietary fat restriction. Future research should include a multi-centre randomised controlled trial to inform evidence-based practice and reduce morbidity, particularly poor growth.
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