[Optimal timing for octreotide administration in adult patients with chylothorax: A scoping review]

Introduction: chylothorax is a rare condition that can cause malnutrition, dehydration, metabolic disturbances, and respiratory failure. Initial management typically includes thoracic drainage and specialized nutritional support. Octreotide, a somatostatin analog, has been considered; however, evidence on the optimal timing for initiation remains limited. Objective: to determine the optimal timing for initiating octreotide in adult patients with chylothorax, exploring dosage, duration, side effects, and clinical outcomes. Methods: a systematic search was conducted in BDTD, Cochrane, Embase, ProQuest DTG, PubMed, PubMed PMC, and Web of Science. Studies including adults treated with octreotide were included, and those combining octreotide with surgical procedures were excluded. Three reviewers independently selected studies, with a fourth resolving discrepancies. JBI and PRISMA-ScR guidelines were followed. The protocol is registered in OSF (https://doi.org/10.17605/OSF.IO/D9WNT). Results: six studies met the inclusion criteria: four retrospective, one prospective, and one case series. Patients' mean age was 48-67.5 years, mostly male. Octreotide doses ranged from 150 to 300 µg/day, primarily via subcutaneous route. Initiation timing and treatment duration (1-16 days) were variable; efficacy ranged from 48.9 % to 100 %. None of the included studies directly addressed the research question, highlighting a gap in scientific knowledge. Conclusions: there is no consensus on the optimal timing for initiating octreotide in adult patients with chylothorax. Prospective studies or clinical trials are needed to define timing, dosage, and duration, supporting safer and more standardized clinical practice.