Richard P. Lion, Melissa M. Winder, Rambod Amirnovin, Kristi Fogg, Rebecca Bertrandt, Priya Bhaskar, Cameron Kasmai, Kathryn W. Holmes, Rohin Moza, Piyagarnt Vichayavilas, Erin E. Gordon, Amiee Trauth, Megan Horsley, Deborah U. Frank, Arabela Stock, Greg Adamson, Alissa Lyman, Tia Raymond, Isaura Diaz, Alicia DeMarco, Parthak Prodhan, Michael Fundora, Alaa Aljiffry, Aaron G. Dewitt, Benjamin W. Kozyak, Lawrence Greiten, Carly Scahill, Jason Buckley, David K. Bailly, PC4 Chylothorax Work Group
Multiple Institutions
United States
Cardiology in the Young
Cardiol Young 2022; 32: 1202-1209
DOI: 10.1017/S1047951122001871
Abstract
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%.
Category
Consensus Guidelines for Pulmonary Vascular Disease
Pulmonary Lymphatic Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
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