Multidisciplinary management of adult patients with chylothorax: a consensus statement

Abhinav Agrawal^{1

2}, Udit Chaddha^{3

2}, Samira Shojaee⁴, Gregory Nadolski⁵, Moishe Liberman⁶, Y C Gary Lee⁷, Najib Rahman⁸, Janani S Reisenauer⁹, Mark K Ferguson¹⁰, Malcolm M DeCamp¹¹, Erin A Gillaspie¹², Eihab O Bedawi¹³, Brian Currie¹⁴, David J Feller-Kopman¹⁵, Ajinkya Desai¹⁶, Kazuhiro Yasufuku¹⁷, Vivian Bishay¹⁸, Yaron Gesthalter¹⁹, Horiana Grosu²⁰, Jeffrey Forris Beecham Chick²¹, Robert Lentz⁴, K Pallav Kolli²², Andrew Kaufman¹⁸, Ravindra M Mehta²³, Kush Desai²⁴, Heather Davis²⁰, Uzair K Ghori²⁵, Fabien Maldonado⁴

Affiliations

¹ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA abhinav72@gmail.com.
² Contributed equally as joint first authors.
³ Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ University of Pennsylvania, Philadelphia, PA, USA.
⁶ University of Montreal, Montreal, QC, Canada.
⁷ University of Western Australia, Perth, Australia.
⁸ Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
⁹ Mayo Clinic, Rochester, MN, USA.
¹⁰ University of Chicago, Chicago, IL, USA.
¹¹ Division of Cardiothoracic Surgery, University of Wisconsin, Madison, WI, USA.
¹² Creighton University Medical Center, Omaha, NE, USA.
¹³ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
¹⁴ New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
¹⁵ Pulmonary and Critical Care Medicine, Darmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹⁶ University of Mississippi Medical Center, Jackson, MS, USA.
¹⁷ Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
¹⁸ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Division of Pulmonary, Critical Care, Allergy and Sleep, University of California San Francisco, San Francisco, CA, USA.
²⁰ University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
²¹ University of Washington, Seattle, WA, USA.
²² Division of Body Interventional Radiology, University of California San Francisco, San Francisco, CA, USA.
²³ Apollo Bangalore Pulmonary Services, Apollo Hospitals Bangalore, Bangalore, India.
²⁴ Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²⁵ Medical College of Wisconsin, Milwaukee, WI, USA.

PMID: 39326915
DOI: 10.1183/13993003.00470-2024

Multidisciplinary management of adult patients with chylothorax: a consensus statement

Abhinav Agrawal et al. Eur Respir J. 2024.

. 2024 Nov 7;64(5):2400470.

doi: 10.1183/13993003.00470-2024. Print 2024 Nov.

Authors

Affiliations

¹ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA abhinav72@gmail.com.
² Contributed equally as joint first authors.
³ Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
⁴ Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
⁵ University of Pennsylvania, Philadelphia, PA, USA.
⁶ University of Montreal, Montreal, QC, Canada.
⁷ University of Western Australia, Perth, Australia.
⁸ Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.
⁹ Mayo Clinic, Rochester, MN, USA.
¹⁰ University of Chicago, Chicago, IL, USA.
¹¹ Division of Cardiothoracic Surgery, University of Wisconsin, Madison, WI, USA.
¹² Creighton University Medical Center, Omaha, NE, USA.
¹³ Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
¹⁴ New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.
¹⁵ Pulmonary and Critical Care Medicine, Darmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
¹⁶ University of Mississippi Medical Center, Jackson, MS, USA.
¹⁷ Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.
¹⁸ Icahn School of Medicine at Mount Sinai, New York, NY, USA.
¹⁹ Division of Pulmonary, Critical Care, Allergy and Sleep, University of California San Francisco, San Francisco, CA, USA.
²⁰ University of Texas, MD Anderson Cancer Center, Houston, TX, USA.
²¹ University of Washington, Seattle, WA, USA.
²² Division of Body Interventional Radiology, University of California San Francisco, San Francisco, CA, USA.
²³ Apollo Bangalore Pulmonary Services, Apollo Hospitals Bangalore, Bangalore, India.
²⁴ Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
²⁵ Medical College of Wisconsin, Milwaukee, WI, USA.

PMID: 39326915
DOI: 10.1183/13993003.00470-2024

Abstract

The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and four specialties (pulmonary, interventional radiology, thoracic surgery and nutrition) with experience and expertise in managing adult patients with chylothorax. We performed a literature and internet search for reports addressing seven clinically relevant PICO (Patient, Intervention, Comparison and Outcome) questions pertaining to the management of adult patients with chylothorax. This consensus statement, consisting of best practice statements based on expert consensus addressing these seven PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with provider experience. Panel members participated in the development of the final best practice statements using the modified Delphi technique. Our consensus statement aims to offer guidance in clinical decision making when managing patients with chylothorax while also identifying gaps in knowledge and informing future research.

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Conflict of interest statement

Conflict of interest: Y.C.G. Lee receives drainage kits without charge for participants of a clinical trial he leads. J.S. Reisenauer has a research grant with Intuitive Surgical and is an educational consultant for Vergent, Isola, Medview and Imvaria, outside the submitted work. M.M. DeCamp is an educational consultant for PulmonX and is on the scientific advisory board for Pleural Dynamics. D.J. Feller-Kopman is an educational consultant for AstraZeneca, Noah Medical and Boston Scientific, outside the submitted work. H. Grosu has a sponsored research agreement with Known Medicine. J.F.B. Chick is an educational consultant and speaker for Inari Medical, Guerbet, C. R. Bard, Argon Medical Devices, Boston Scientific, NXT Biomedical and AiDoc, outside the submitted work. F. Maldonado received research funding from Medtronic and personal consulting fees from J&J and Intuitive, outside of the submitted work. The remaining authors do not have any disclosures or conflicts of interest to report.

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Multidisciplinary management of adult patients with chylothorax: a consensus statement

Affiliations

Multidisciplinary management of adult patients with chylothorax: a consensus statement

Authors

Affiliations

Abstract

Conflict of interest statement

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