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Medical Interventions for Chylothorax and their Impacts on Need for Surgical Intervention and Admission

Rohit S Loomba1,2, Joshua Wong2, Megan Davis2

  • 1Department of Pediatrics, Chicago Medical School, Chicago, IL, USA.

Pediatric Cardiology
|January 4, 2021
PubMed

Insights

Pediatric patients with chylothorax after heart surgery may benefit from steroids and furosemide, potentially avoiding surgery. This study analyzed interventions for post-cardiac surgery chylothorax in children.

Area of Science:

  • Pediatric Cardiology
  • Thoracic Surgery
  • Critical Care Medicine

Background:

  • Chylothorax affects 1-9% of pediatric patients post-congenital heart surgery.
  • Limited evidence-based practices exist for managing pediatric post-operative chylothorax.
  • This study examines interventions for pediatric cardiac surgery patients with chylothorax.

Purpose of the Study:

  • To characterize pediatric patients undergoing cardiac surgery and chylothorax requiring intervention.
  • To establish objective data on the impact of medical interventions for pediatric chylothorax.
  • To identify factors associated with increased odds of surgical intervention for chylothorax.

Main Methods:

  • Retrospective analysis of the Pediatric Health Information System database (2004-2015).
  • Inclusion criteria: pediatric admissions, cardiac diagnosis, cardiac surgery, and chylothorax.
  • Patients divided into surgical and non-surgical intervention groups for chylothorax.

Main Results:

  • 9.4% of 3503 pediatric cardiac surgery admissions with chylothorax required surgical intervention.
  • Specific diagnoses (e.g., d-transposition) and comorbidities (e.g., acute kidney injury, ECMO) increased odds of surgical intervention.
  • Steroids (dexamethasone, methylprednisolone) and furosemide were associated with decreased length of stay, costs, and odds of surgical intervention.

Conclusions:

  • Medical interventions including specific steroids and furosemide show significant impact on managing pediatric post-operative chylothorax.
  • These interventions are associated with reduced length of stay, costs, and need for surgical procedures.
  • Most post-operative chylothoraxes in pediatric cardiac surgery patients may resolve with furosemide, a low-fat diet, and steroids.

Keywords:
Cardiac surgical procedureChylothoraxCongenital heart defectsLength of stayMortalityPediatrics

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