Search

We hypothesize that there are post-operative, non-surgical risk factors that could be modified to prevent the occurrence of chylothorax, and we seek to determine those factors. Retrospective chart review of 285 consecutive patients < 18 years who underwent cardiac surgery from 2015 to 2017 at a single institution pediatric intensive care unit. Data was collected on patient demographics, cardiac lesion, surgical and post-operative characteristics. Primary outcome was development of chylothorax. Of 285 patients, median age was 189 days, median weight was 6.6 kg, 48% were female, and 10% had trisomy 21. 3.5% of patients developed upper extremity DVTs, and 8% developed chylothorax. At 24 h following surgery, a majority were in the 0–10% fluid overload category or had a negative fluid balance (63% and 34%, respectively), and a positive fluid balance was rare at 72 h (16%). In univariate analysis, age, weight, bypass time, DVT, arrhythmia, and trisomy 21 were significantly associated with chylothorax and adjusted for in logistic regression. Presence of an upper extremity DVT (OR 49.8, p < 0.001) and trisomy 21 (OR 5.8, p < 0.001) remained associated with chylothorax on regression modeling. The presence of an upper extremity DVT and trisomy 21 were associated with the development of chylothorax. Fluid overload was rare in our population. The presence of positive fluid balance, fluid overload, elevated central venous pressure, and early initiation of fat containing feeds were not associated with chylothorax. [ABSTRACT FROM AUTHOR]

Introduction: The Pediatric Acute Care Cardiology Collaborative (PAC3) was established in 2014 to understand systems and clinical practices in cardiac care delivered outside the intensive care unit with a focus on outcomes, quality improvement, and patient safety. An initial PAC3 project was a comprehensive survey to understand unit structure, practices, and resource utilization across the collaborative. Methods: The survey consisted of 126 stem questions. Many questions had branching logic for positive responses leading to 412 total possible response fields. Questions were categorized into domains: demographics, staffing, resources and therapies, and standard care practices. Five supplemental questions addressed patient and surgical volume variables. Responses were recorded and stored in a REDCap database. Results: Surveys were completed by 31 (91%) of 34 member centers. A majority (19, 61%) of centers have a single, dedicated cardiac acute care unit (ACU), which is contiguous or on the same floor as the ICU in 15 (48%). A nurse staffing ratio of 3:1 is employed in 71% of centers and 26 (84%) reported having a resource nurse. Centralized wireless rhythm monitoring is used in 26 (84%) centers with 14 (54%) staffed continuously. Table 1 shows the use of various high-acuity therapies. Figure 1 illustrates the varied use of protocols and procedures in this population. Conclusions: The PAC3 hospital survey is the most thorough effort to understand systems and clinical care practices in the cardiac ACU to date. It demonstrates notable heterogeneity and varied practice patterns amongst units. Further study may identify a combination of structure and services that can enhance efficiency, safety, and patient outcomes. [ABSTRACT FROM AUTHOR]