Nutritional Management - Peds Post Op Chylo

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Clinical Practice Question

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
Show and explain pictures

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

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