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A protocol to decrease postoperative chylous effusion duration in children

Published online by Cambridge University Press:  25 April 2018

Melissa M. Winder ,
Aaron W. Eckhauser ,
Claudia Delgado-Corcoran ,
Randall J. Smout ,
Jennifer Marietta  and
David K. Bailly
Melissa M. Winder*
Affiliation:
Department of Pediatric Critical Care, Primary Children’s Hospital, Salt Lake City, UT, USA
Aaron W. Eckhauser
Affiliation:
Division of Pediatric Cardiothoracic Surgery, University of Utah, Salt Lake City, UT, USA
Claudia Delgado-Corcoran
Affiliation:
Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
Randall J. Smout
Affiliation:
Continuous Improvement, Primary Children’s Hospital, Salt Lake City, UT, USA
Jennifer Marietta
Affiliation:
Heart Center, Primary Children’s Hospital, Salt Lake City, UT, USA
David K. Bailly
Affiliation:
Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA
*
Author for correspondence: M. M. Winder, CPNP-AC, Department of Pediatric Critical Care, Primary Children’s Hospital, 100 N Mario Capecchi Dr, Salt Lake City, UT 84113, USA. Tel: 801 647 1680; Fax: 801 662 2412; E-mail: melissa.winder@imail.org
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Abstract

Objective

Our primary goal was to decrease time to resolution of postoperative chylothorax as demonstrated by total days of chest tube utilisation through development and implementation of a management protocol.

Methods

A chylothorax management protocol was implemented as a quality improvement project at a tertiary-care paediatric hospital in July, 2015. Retrospective analysis was completed on patients aged 0–17 years diagnosed with chylothorax within 30 days of cardiac surgery in a pre-protocol cohort (February, 2014 to June, 2015, n=20) and a post-protocol cohort (July, 2015 to March, 2016, n=22).

Measurements and results

Patient characteristics were similar before and after protocol implementation. Duration of mechanical ventilation and cardiac ICU and hospital lengths of stay were unchanged between cohorts. Following protocol implementation, total duration of chest tube utilisation decreased from 12 to 7 days (p=0.047) with a decrease in maximum days of chest tube utilisation from 44 to 13 days. Duration of medium-chain triglyceride feeds decreased from 42 days to 31 days (p=0.01). In total, three patients in the post-protocol cohort underwent additional surgical procedures to treat chylothorax with subsequent resolution of chylothorax within 24 hours. There were no chest tube re-insertions or re-admissions related to chylothorax in either the pre- or post-protocol cohorts. Protocol compliance was 81%.

Conclusions

Adoption of a chylothorax management protocol is feasible, and in our small cohort of patients implementation led to a significant decrease in the duration of chest tube utilisation, while eliminating practice variability among providers.

Keywords

Paediatricsheart defectschylothoraxclinical protocolsquality improvement
Type
Original Articles
Information
Cardiology in the Young , Volume 28 , Issue 6 , June 2018 , pp. 816 - 825
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Copyright
© Cambridge University Press 2018 

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