Efficacy of nil per oral, total parenteral nutrition, milrinone and non-suction chest tube drainage-based management for chylothorax following pediatric cardiac surgery.

IF 0.7 Q3 Medicine

ASIAN CARDIOVASCULAR & THORACIC ANNALS Pub Date : 2024-04-24 DOI:10.1177/02184923241249198

M. R. Rahmath, A. Bhat, R. A. Lone, R. Kamal

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引用次数: 0

Abstract

OBJECTIVE A single centre experience with chylothorax in post cardiac surgical patients. METHODS Retrospective review. RESULTS Chylothorax developed in 55 out of 873 operated patients (6.3%). Median age of the chylothorax cohort was 95 days (range 1-995). Neonates constituted 36% and 49% were infants. Group-1(35 patients-treated during the years 2011-2015) included those who were managed with low fat diet initially with other standard measures including steroid, octreotide, pleurodesis, lymphangiogram or thoracic duct ligation whenever required.Group-2 (20 patients, treated between year 2016-2018) were managed with nil per oral, total parenteral nutrition, extended use of milrinone and no use of chest tube suction with other above standard measures when required.Group-1 and group-2 were comparable in terms of their age and weight (p > 0.05).We observed lower volume of chest drainage, shorter intubation time, length of intensive care stay and hospital stay in group-2 compared to group-1 though they were statistically not significant (p > 0.05). Occurrence of massive chylothorax (>20 ml/kg/day) in group-1 was significantly higher [18 patients (51%) in group-1 vs 4 patients in group-2 (20%) (Chi-square 5.25, p = 0.02)]. In hospital mortality in group-1 was higher compared to group-2 (5/35 = 14.5% vs 1/20 = 5%), however, it was statistically not significant [risk ratio 2.86; 95% CI 0.36, 22.77; p = 0.59)]. Acute kidney injury was observed in about 25% of patients who had chylothorax. A higher mortality was observed in patients with chylothorax who had acute kidney injury [5/14 (35%)] compared to those who did not have acute kidney injury [1/41 (2.4%)] (Chi-square 11.89, p = 0.001)]. SUMMARY In a heterogenous cohort of post-cardiac surgical patients who developed chylothorax, our suggested new regime (nil per oral, parenteral nutrition, extended use of milrinone and no suction applied to the chest drains) contributed to reduce the frequency of massive chylothorax occurrence significantly.

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针对小儿心脏手术后的乳糜胸，采用零口服、全胃肠外营养、米力农和无抽吸胸管引流术的疗效。

结果 873 例手术患者中有 55 例（6.3%）出现了乳糜胸。乳糜胸患者的中位年龄为 95 天（1-995 天不等）。新生儿占 36%，婴儿占 49%。第1组（35名患者，治疗时间为2011-2015年）包括最初采用低脂饮食并在必要时采取其他标准措施（包括类固醇、奥曲肽、胸膜穿刺术、淋巴管造影或胸导管结扎术）的患者。第2组（20名患者，治疗时间为2016-2018年）在必要时采用零口服、全胃肠外营养、延长米力农的使用时间、不使用胸管抽吸术以及其他上述标准措施。我们观察到，与第一组相比，第二组的胸腔引流量更少、插管时间更短、重症监护时间更长、住院时间更短，但这些数据在统计学上并不显著（P>0.05）。第一组出现大量乳糜胸（>20 毫升/千克/天）的比例明显更高[第一组有 18 名患者（51%），第二组有 4 名患者（20%）（Chi-square 5.25，P = 0.02）]。与第二组相比，第一组的住院死亡率更高（5/35 = 14.5% vs 1/20 = 5%），但在统计学上并不显著[风险比 2.86; 95% CI 0.36, 22.77; p = 0.59]]。约 25% 的乳糜胸患者出现急性肾损伤。与未出现急性肾损伤的患者[1/41 (2.4%)]相比，出现急性肾损伤的乳糜胸患者死亡率更高[5/14 (35%)]（Chi-square 11.89, p = 0.001）]。总结：在一组心脏手术后出现乳糜胸的不同类型患者中，我们建议的新方案（无口服肠外营养、延长米力农的使用时间以及不对胸腔引流管进行抽吸）有助于显著降低大面积乳糜胸的发生率。

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来源期刊

ASIAN CARDIOVASCULAR & THORACIC ANNALS Multiple-

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1.30

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0.00%

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期刊介绍： The Asian Cardiovascular and Thoracic Annals is an international peer-reviewed journal pertaining to cardiovascular and thoracic medicine. Besides original clinical manuscripts, we welcome research reports, product reviews, reports of new techniques, and findings of special significance to Asia and the Pacific Rim. Case studies that have significant novel original observations, are instructive, include adequate methodological details and provide conclusions. Workshop proceedings, meetings and book reviews, letters to the editor, and meeting announcements are encouraged along with relevant articles from authors.