[Chylothorax: experience in a paediatric intensive care unit].
BACKGROUND
Chylothorax is a fairly common condition seen in paediatric intensive care units, since it usually appears in the postoperative care of cardiothoracic surgery. Nevertheless, there is still uncertainty on the most effective treatment option and the prognostic factors for a positive response.


OBJECTIVE
To describe our experience in the management of patients with chylothorax admitted to our paediatric intensive care unit (PICU). To look for prognostic factors for a response to the different treatments.


METHODS
This is a descriptive and analytical, retrospective study, that includes the period 2000-2007. All cases of chylothorax of any aetiology diagnosed during this period in our PICU were included (excluding congenital neonatal cases). Demographic variables, aetiology, evolution of the debit, complications, type of treatment with results and side effects were recorded, along with the clinical progress. The possible relationship between the different variables (age, aetiology, debit), and progress, as well as response to treatments was analysed.


RESULTS
A total of 24 patients, 12 males and 12 females, were included, of which 70.8% (17) were under 1 year of age. A total of 79.2% (19) were in postoperative care after surgery for a congenital heart disease. The most notable complications were sepsis (3/24 cases, 12.5%), hypoalbuminaemia (3/24, 12.5%), haemodynamic changes (2/24, 8.3%) and catheter-associated sepsis (2/16, 12.5%). The treatment with fat-free or rich in medium chain triglycerides diet was effective in 9/21 cases (43%) and total parenteral nutrition in 3/5 (60%), as opposed to the infusion of somatostatin in 8/11 (73%), used in second or third line. Somatostatin side effects were hypoglycaemia, hyperglycaemia and digestive disturbances, one patient in each case, and not causing complications. We did not find prognostic factors as regards progression or for the response to the different treatments.


CONCLUSIONS
Sepsis, hypoalbuminaemia and haemodynamic disturbances were found to be complications associated to chylothorax. The treatment with somatostatin did not produce severe side effects, and there was a positive response in 73% of those treated with it.
Lumbreras Fernández
J
J
Departamento de Pediatría, Hospital Universitario 12 de Octubre, Madrid, España. jlumfer@gmail.com
Sánchez Díaz
J I
JI
D002648:Child; D002675:Child, Preschool; D002916:Chylothorax / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies