Development of consensus recommendations for the management of post-operative chylothorax in paediatric CHD

Richard P. Lion, Melissa M. Winder, Rambod Amirnovin, Kristi Fogg, Rebecca Bertrandt, Priya Bhaskar, Cameron Kasmai, Kathryn W. Holmes, Rohin Moza, Piyagarnt Vichayavilas, Erin E. Gordon, Amiee Trauth, Megan Horsley, Deborah U. Frank, Arabela Stock, Greg Adamson, Alissa Lyman, Tia Raymond, Isaura Diaz, Alicia DemarcoParthak Prodhan, Michael Fundora, Alaa Aljiffry, Aaron G. Dewitt, Benjamin W. Kozyak, Lawrence Greiten, Carly Scahill, Jason Buckley, David K. Bailly

Research output: Contribution to journalReview articlepeer-review

4 Scopus citations


Objective: A standardised multi-site approach to manage paediatric post-operative chylothorax does not exist and leads to unnecessary practice variation. The Chylothorax Work Group utilised the Pediatric Critical Care Consortium infrastructure to address this gap. Methods: Over 60 multi-disciplinary providers representing 22 centres convened virtually as a quality initiative to develop an algorithm to manage paediatric post-operative chylothorax. Agreement was objectively quantified for each recommendation in the algorithm by utilising an anonymous survey. Consensus was defined as ≥ 80% of responses as agree or strongly agree to a recommendation. In order to determine if the algorithm recommendations would be correctly interpreted in the clinical environment, we developed ex vivo simulations and surveyed patients who developed the algorithm and patients who did not. Results: The algorithm is intended for all children (<18 years of age) within 30 days of cardiac surgery. It contains rationale for 11 central chylothorax management recommendations; diagnostic criteria and evaluation, trial of fat-modified diet, stratification by volume of daily output, timing of first-line medical therapy for low and high volume patients, and timing and duration of fat-modified diet. All recommendations achieved consensus (agreement >80%) by the workgroup (range 81-100%). Ex vivo simulations demonstrated good understanding by developers (range 94-100%) and non-developers (73%-100%). Conclusions: The quality improvement effort represents the first multi-site algorithm for the management of paediatric post-operative chylothorax. The algorithm includes transparent and objective measures of agreement and understanding. Agreement to the algorithm recommendations was >80%, and overall understanding was 94%.

Original languageEnglish (US)
Pages (from-to)1202-1209
Number of pages8
JournalCardiology in the Young
Issue number8
StatePublished - Aug 6 2022


  • Chylothorax
  • cardiac surgery
  • consensus
  • guidelines
  • paediatric

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine


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