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Development of consensus recommendations for the management of post-operative chylothorax in paediatric CHD.
Lion, Richard P; Winder, Melissa M; Amirnovin, Rambod; Fogg, Kristi; Bertrandt, Rebecca; Bhaskar, Priya; Kasmai, Cameron; Holmes, Kathryn W; Moza, Rohin; Vichayavilas, Piyagarnt; Gordon, Erin E; Trauth, Amiee; Horsley, Megan; Frank, Deborah U; Stock, Arabela; Adamson, Greg; Lyman, Alissa; Raymond, Tia; Diaz, Isaura; DeMarco, Alicia; Prodhan, Parthak; Fundora, Michael; Aljiffry, Alaa; Dewitt, Aaron G; Kozyak, Benjamin W; Greiten, Lawrence; Scahill, Carly; Buckley, Jason; Bailly, David K.
Afiliación
  • Lion RP; Department of Pediatrics, Division of Pediatric Cardiac Critical Care, University of Texas, Austin, TX, USA.
  • Winder MM; Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
  • Amirnovin R; Department of Pediatrics, Division of Pediatric Critical Care Medicine, Loma Linda University, Loma Linda, CA, USA.
  • Fogg K; Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA.
  • Bertrandt R; Department of Pediatrics, Division of Pediatric Critical Care, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Bhaskar P; Department of Pediatrics, Division of Critical Care Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
  • Kasmai C; Department of Pediatrics, Division of Pediatric Critical Care, Children's Wisconsin, Medical College of Wisconsin, Milwaukee, WI, USA.
  • Holmes KW; Department of Pediatrics, Division of Pediatric Cardiology, OHSU Doernbecher Children's Hospital, Portland, OR, USA.
  • Moza R; Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, UT, USA.
  • Vichayavilas P; Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado-Denver, Aurora, CO, USA.
  • Gordon EE; Department of Pediatrics, Division of Pediatric Critical Care, University of Texas Southwestern, Dallas, TX, USA.
  • Trauth A; Department of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
  • Horsley M; Department of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
  • Frank DU; Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Virginia, Charlottesville, VA, USA.
  • Stock A; Department of Pediatrics, Division of Cardiac Critical Care, Johns Hopkins All Children's, St Petersburg, FL, USA.
  • Adamson G; Department of Pediatrics, Division of Pediatric Cardiology, Stanford University/Lucile Packard Children's Hospital, Palo Alto, CA, USA.
  • Lyman A; Department of Pediatrics, Division of Pediatric Cardiology, OHSU Doernbecher Children's Hospital, Portland, OR, USA.
  • Raymond T; Department of Pediatrics, Division of Cardiac Critical Care, Medical City Children's Hospital, Dallas, TX, USA.
  • Diaz I; Department of Pediatrics, Division of Critical Care Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN, USA.
  • DeMarco A; Department of Pediatrics, Division of Anesthesiology/Critical Care Medicine, USC Keck School of Medicine, Los Angeles, CA, USA.
  • Prodhan P; Department of Pediatrics, Division of Pediatric Cardiology, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, AR, USA.
  • Fundora M; Department of Pediatrics, Division of Cardiology, Children's Healthcare of Aitlanta, Emory University School of Medicine, Atlanta, GA, USA.
  • Aljiffry A; Department of Pediatrics, Division of Cardiology, Children's Healthcare of Aitlanta, Emory University School of Medicine, Atlanta, GA, USA.
  • Dewitt AG; Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
  • Kozyak BW; Department of Anesthesiology and Critical Care Medicine, Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia and Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.
  • Greiten L; Department of Surgery, Division of Pediatric Cardiothoracic Surgery, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR, USA.
  • Scahill C; Department of Pediatrics, Division of Pediatric Cardiology, University of Colorado, Denver, Aurora, CO, USA.
  • Buckley J; Department of Pediatrics, Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, SC, USA.
  • Bailly DK; Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, UT, USA.
Cardiol Young ; 32(8): 1202-1209, 2022 Aug.
Article en En | MEDLINE | ID: mdl-35792060
OBJECTIVE: A standardised multi-site approach to manage paediatric post-operative chylothorax does not exist and leads to unnecessary practice variation. The Chylothorax Work Group utilised the Pediatric Critical Care Consortium infrastructure to address this gap. METHODS: Over 60 multi-disciplinary providers representing 22 centres convened virtually as a quality initiative to develop an algorithm to manage paediatric post-operative chylothorax. Agreement was objectively quantified for each recommendation in the algorithm by utilising an anonymous survey. "Consensus" was defined as ≥ 80% of responses as "agree" or "strongly agree" to a recommendation. In order to determine if the algorithm recommendations would be correctly interpreted in the clinical environment, we developed ex vivo simulations and surveyed patients who developed the algorithm and patients who did not. RESULTS: The algorithm is intended for all children (<18 years of age) within 30 days of cardiac surgery. It contains rationale for 11 central chylothorax management recommendations; diagnostic criteria and evaluation, trial of fat-modified diet, stratification by volume of daily output, timing of first-line medical therapy for "low" and "high" volume patients, and timing and duration of fat-modified diet. All recommendations achieved "consensus" (agreement >80%) by the workgroup (range 81-100%). Ex vivo simulations demonstrated good understanding by developers (range 94-100%) and non-developers (73%-100%). CONCLUSIONS: The quality improvement effort represents the first multi-site algorithm for the management of paediatric post-operative chylothorax. The algorithm includes transparent and objective measures of agreement and understanding. Agreement to the algorithm recommendations was >80%, and overall understanding was 94%.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Quilotórax / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline Límite: Child / Humans Idioma: En Revista: Cardiol Young Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / PEDIATRIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Quilotórax / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Diagnostic_studies / Etiology_studies / Guideline Límite: Child / Humans Idioma: En Revista: Cardiol Young Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA / PEDIATRIA Año: 2022 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Reino Unido