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Comparative Study
. 2013 Sep;96(3):930-6.
doi: 10.1016/j.athoracsur.2013.05.058. Epub 2013 Jul 31.

Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient

Jay Yeh  1 , Erin R Brown, Kimberly A Kellogg, Janet E Donohue, Sunkyung Yu, Michael G Gaies, Carlen G Fifer, Jennifer C Hirsch, Ranjit Aiyagari
Affiliations
Comparative Study

Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient

Jay Yeh et al. Ann Thorac Surg. 2013 Sep.

Abstract

Background: Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention.

Methods: After institution of a clinical practice guideline for management of postoperative chylothorax at a single center, pediatric cardiothoracic intensive care unit (ICU) in June 2010, we retrospectively analyzed 2 cohorts of patients: those with chylothorax from January 2008 to May 2010 (early cohort; n=118) and from June 2010 to August 2011 (late cohort; n=45). Data collected included demographics, cardiac surgical procedure, treatments for chylothorax, bloodstream infections, hospital mortality, length of hospitalization, duration of mechanical ventilation, and device utilization.

Results: There were no demographic differences between the cohorts. No differences were found in octreotide use or surgical treatments for chylothorax. Significant differences were found in median times to chylothorax diagnosis (9 in early cohort versus 6 days in late cohort, p=0.004), ICU length of stay (18 vs 9 days, p=0.01), hospital length of stay (30 vs 23 days, p=0.005), and total durations of mechanical ventilation (11 vs 5 days, p=0.02), chest tube use (20 vs 14 days, p=0.01), central venous line use (27 vs 15 days, p=0.001), and NPO status (9.5 vs 6 days, p=0.04).

Conclusions: Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.

Keywords: 18; BSI; CPG; CVL; EC; ICU; LC; NPO; RACHS-1; Risk Adjustment for Congenital Heart Surgery; TPN; bloodstream infections; central venous line; clinical practice guideline; early cohort; intensive care unit; late cohort; nil per os; total parenteral nutrition.

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Figures

Figure 1
Figure 1
Flow diagram demonstrating the recommended progressive therapies.
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Comment in

  • Invited commentary.
    Pelletier GJ. Pelletier GJ. Ann Thorac Surg. 2013 Sep;96(3):936-7. doi: 10.1016/j.athoracsur.2013.06.026. Ann Thorac Surg. 2013. PMID: 23992691 No abstract available.

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