Marino L V, Bell K L, Woodgate J, Doolan A
Department of Dietetics/SLT.
NIHR Biomedical Research Centre Southampton, Faculty of Health Sciences.
Cardiol Young. 2019 Sep;29(9):1127-1136. doi: 10.1017/S1047951119001525. Epub 2019 Aug 15.
Although chylothorax is an uncommon complication following paediatric cardiothoracic surgery, it has significant associated morbidities and increased in-hospital mortality, as well as results in higher costs. A lack of prospective evidence or consensus guidelines for management of chylothorax further hinders optimal management. The aim of this survey was to characterise variations in practice in the management of chylothorax and to identify areas for future research.
A descriptive, observational survey investigating conservative management practices of chylothorax was distributed internationally to health-care professionals in paediatric intensive care and cardiology units. The survey investigated five domains: the first providing general information about health-care professionals and four domains focusing on clinical practice including diet composition and duration.
In total, sixty-four health-care professionals completed the survey, representing 38 organisations from 16 countries. The respondents were dietitians (80%), physicians (19%), and nurses (1%). In Australia and New Zealand, management was most commonly directed by physicians' preference (67%) as compared to unit protocols in Europe (67%), United States of America (67%), and Other regions (55%). Dietitians in Australia/New Zealand, United Kingdom, and Ireland followed the most restrictive diet therapy recommending <5 g long chain triglyceride fat per day (p < 0.00001). The duration of diet therapy significantly varied between regions: Australia/New Zealand: 4 weeks (36%) and 6 weeks (43%); Europe: 4 weeks (25%) and 6 weeks (57%); and North America: 4 weeks (18%) and 6 weeks (75%) (p < 0.00001).
This survey highlights international variations in practice in the management of chylothorax, particularly with respect to treatment duration and dietary fat restriction. Future research should include a multi-centre randomised controlled trial to inform evidence-based practice and reduce morbidity, particularly poor growth.
尽管乳糜胸是小儿心胸外科手术后一种不常见的并发症，但它伴有严重的相关疾病，会增加住院死亡率，还会导致成本升高。缺乏关于乳糜胸管理的前瞻性证据或共识指南进一步阻碍了最佳管理。本次调查的目的是描述乳糜胸管理实践中的差异，并确定未来研究的领域。
一项关于乳糜胸保守管理实践的描述性观察性调查在国际上分发给小儿重症监护和心脏病科的医护人员。该调查涵盖五个领域：第一个领域提供关于医护人员的一般信息，另外四个领域聚焦于临床实践，包括饮食构成和持续时间。
共有64名医护人员完成了调查，代表来自16个国家的38个机构。受访者中营养师占80%，医生占19%，护士占1%。在澳大利亚和新西兰，管理最常由医生的偏好主导（67%），而在欧洲（67%）、美国（67%）和其他地区（55%）则由科室方案主导。澳大利亚/新西兰、英国和爱尔兰的营养师采用最严格的饮食疗法，建议每天长链甘油三酯脂肪摄入量<5克（p<0.00001）。饮食疗法的持续时间在不同地区有显著差异：澳大利亚/新西兰：4周（36%）和6周（43%）；欧洲：4周（25%）和6周（57%）；北美：4周（18%）和6周（75%）（p<0.00001）。
本次调查突出了乳糜胸管理实践中的国际差异，特别是在治疗持续时间和饮食脂肪限制方面。未来的研究应包括一项多中心随机对照试验，以提供循证实践依据并降低发病率，尤其是生长发育不良的情况。
