What is the best way to nutritionally manage patients who develop a chylothorax after pediatric congenital heart surgery?
What is a chylothorax?
Collection of chylous fluid in pleural space due to accidentally knicking a lymph duct during surgery or due to the increase in SVR after their repair changes blood flow
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Significance
Chylothorax is a rare situation, but common in my ICU due to Utah’s high elevation
Potentially life-threatening, will increase hospitalization
Benefits of breast milk and nutrition in general
Heart patients are already at risk
Synthesis
When to initiate a protocol
High vs low output chylothorax
High: greater than 20 mL of output per kg per day
Low: 15-20 mL per kg per day
Protocol was standardized after chylothorax workgroup meeting in 2022
Nutritional management
Low-fat intake diet via food or breast milk for low-output chylothorax for 10 days to 6 weeks
Risks of low-fat
Breast milk's caloric value is decreased and must be fortified
Decreased vitamin absorption
Inadequate development and immune dysfunction
NPO for 6 days to 3 weeks for high-output chylothorax
Risks of NPO
Bacterial translocation
Fussiness
Feeding aversions
Positive outcome definition
Chest tube days
Overall hospital length decreased
Intubation days
ICU days
Ability to implement a protocol
Practice implications
Protocol development
Needs more research
Provider-to-provider differences
Standardization
Proven to be possible
Nutritional optimization
Appropriate growth and development
Decreased NPO days
Advocacy
Nurses having a protocol allows us to advocate for evidence-based treatment
