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An international survey of the nutrition management of chylothorax: a time for change
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 furthe...
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| Published in: | Cardiology in the young 2019-09, Vol.29 (9), p.1127-1136 |
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| container_title | Cardiology in the young |
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| creator | Marino, L. V. Bell, K. L. Woodgate, J. Doolan, A. |
| description | 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 |
| doi_str_mv | 10.1017/S1047951119001525 |
| format | article |
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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.</description><identifier>ISSN: 1047-9511</identifier><identifier>EISSN: 1467-1107</identifier><identifier>DOI: 10.1017/S1047951119001525</identifier><identifier>PMID: 31414980</identifier><language>eng</language><publisher>Cambridge, UK: Cambridge University Press</publisher><subject>Breastfeeding & lactation ; Cardiac Surgical Procedures - adverse effects ; Cardiology ; Cardiovascular disease ; Child ; Child, Preschool ; Chylothorax - epidemiology ; Chylothorax - therapy ; Clinical medicine ; Congenital diseases ; Consent ; Conservative Treatment - methods ; Cross-Sectional Studies ; Diet ; Diet, Fat-Restricted - methods ; Dietitians ; Disease Management ; Domains ; Fatty acids ; Global Health ; Health ; Heart surgery ; Hospitals ; Humans ; Identification methods ; Infant ; Intensive care ; Lipids ; Malnutrition ; Management ; Medical personnel ; Metabolism ; Morbidity ; Morbidity - trends ; Mortality ; Nutrition ; Nutrition research ; Nutrition Surveys - methods ; Original Article ; Parenteral nutrition ; Pediatrics ; Physicians ; Polls & surveys ; Postoperative Complications ; Practice Guidelines as Topic ; Professionals ; Prospective Studies ; Therapy ; Triglycerides</subject><ispartof>Cardiology in the young, 2019-09, Vol.29 (9), p.1127-1136</ispartof><rights>Cambridge University Press 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c373t-7bc641860d617ba0b3d29810bf4fc895b1093e4f09d57f9bb0e4cef6568947773</citedby><cites>FETCH-LOGICAL-c373t-7bc641860d617ba0b3d29810bf4fc895b1093e4f09d57f9bb0e4cef6568947773</cites><orcidid>0000-0002-1257-121X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.cambridge.org/core/product/identifier/S1047951119001525/type/journal_article$$EHTML$$P50$$Gcambridge$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,72731</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/31414980$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Marino, L. V.</creatorcontrib><creatorcontrib>Bell, K. L.</creatorcontrib><creatorcontrib>Woodgate, J.</creatorcontrib><creatorcontrib>Doolan, A.</creatorcontrib><creatorcontrib>British Dietetic Association Paediatric Cardiology Interest Group</creatorcontrib><creatorcontrib>British Dietetic Association Paediatric Cardiology Interest Group</creatorcontrib><title>An international survey of the nutrition management of chylothorax: a time for change</title><title>Cardiology in the young</title><addtitle>Cardiol Young</addtitle><description>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.</description><subject>Breastfeeding & lactation</subject><subject>Cardiac Surgical Procedures - adverse effects</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Chylothorax - epidemiology</subject><subject>Chylothorax - therapy</subject><subject>Clinical medicine</subject><subject>Congenital diseases</subject><subject>Consent</subject><subject>Conservative Treatment - methods</subject><subject>Cross-Sectional Studies</subject><subject>Diet</subject><subject>Diet, Fat-Restricted - methods</subject><subject>Dietitians</subject><subject>Disease Management</subject><subject>Domains</subject><subject>Fatty acids</subject><subject>Global Health</subject><subject>Health</subject><subject>Heart surgery</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Identification methods</subject><subject>Infant</subject><subject>Intensive care</subject><subject>Lipids</subject><subject>Malnutrition</subject><subject>Management</subject><subject>Medical personnel</subject><subject>Metabolism</subject><subject>Morbidity</subject><subject>Morbidity - trends</subject><subject>Mortality</subject><subject>Nutrition</subject><subject>Nutrition research</subject><subject>Nutrition Surveys - methods</subject><subject>Original Article</subject><subject>Parenteral nutrition</subject><subject>Pediatrics</subject><subject>Physicians</subject><subject>Polls & surveys</subject><subject>Postoperative Complications</subject><subject>Practice Guidelines as Topic</subject><subject>Professionals</subject><subject>Prospective Studies</subject><subject>Therapy</subject><subject>Triglycerides</subject><issn>1047-9511</issn><issn>1467-1107</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><recordid>eNp1kM1O3TAQha2qVaHQB2BTWeqGTYontuOYHUL0R0JiUVhHdjK-Nyixqe1UvW-PI26pVMRqRnO-OaM5hJwA-wIM1NlPYEJpCQCaMZC1fEMOQTSqAmDqbemLXK36AfmQ0n1hOAf2nhxwECB0yw7J3YWno88Yvclj8GaiaYm_cUeDo3mL1C85jqtCZ-PNBmf0edX67W4KeRui-XNODc3jjNSFWObGb_CYvHNmSvhxX4_I3der28vv1fXNtx-XF9dVzxXPlbJ9I6Bt2NCAsoZZPtS6BWadcH2rpQWmOQrH9CCV09YyFD26RjatFkopfkROn3wfYvi1YMrdPKYep8l4DEvq6lpxJYXUTUE__4feh6V8Pa2ULlQjVV0oeKL6GFKK6LqHOM4m7jpg3Zp59yLzsvNp77zYGYfnjb8hF4DvTc1s4zhs8N_t120fAdWkihw</recordid><startdate>201909</startdate><enddate>201909</enddate><creator>Marino, L. 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L.</creator><creator>Woodgate, J.</creator><creator>Doolan, A.</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TS</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M7Z</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-1257-121X</orcidid></search><sort><creationdate>201909</creationdate><title>An international survey of the nutrition management of chylothorax: a time for change</title><author>Marino, L. V. ; Bell, K. 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V.</au><au>Bell, K. L.</au><au>Woodgate, J.</au><au>Doolan, A.</au><aucorp>British Dietetic Association Paediatric Cardiology Interest Group</aucorp><aucorp>British Dietetic Association Paediatric Cardiology Interest Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>An international survey of the nutrition management of chylothorax: a time for change</atitle><jtitle>Cardiology in the young</jtitle><addtitle>Cardiol Young</addtitle><date>2019-09</date><risdate>2019</risdate><volume>29</volume><issue>9</issue><spage>1127</spage><epage>1136</epage><pages>1127-1136</pages><issn>1047-9511</issn><eissn>1467-1107</eissn><abstract>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.</abstract><cop>Cambridge, UK</cop><pub>Cambridge University Press</pub><pmid>31414980</pmid><doi>10.1017/S1047951119001525</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-1257-121X</orcidid></addata></record> |
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| subjects | Breastfeeding & lactation Cardiac Surgical Procedures - adverse effects Cardiology Cardiovascular disease Child Child, Preschool Chylothorax - epidemiology Chylothorax - therapy Clinical medicine Congenital diseases Consent Conservative Treatment - methods Cross-Sectional Studies Diet Diet, Fat-Restricted - methods Dietitians Disease Management Domains Fatty acids Global Health Health Heart surgery Hospitals Humans Identification methods Infant Intensive care Lipids Malnutrition Management Medical personnel Metabolism Morbidity Morbidity - trends Mortality Nutrition Nutrition research Nutrition Surveys - methods Original Article Parenteral nutrition Pediatrics Physicians Polls & surveys Postoperative Complications Practice Guidelines as Topic Professionals Prospective Studies Therapy Triglycerides |
| title | An international survey of the nutrition management of chylothorax: a time for change |
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