title: A defined management strategy improves early outcomes after the Fontan procedure: the PORTLAND protocol.
abstract: BACKGROUND
  Patients undergoing the Fontan procedure may have extended hospital stay due to various postoperative factors including prolonged chest tube drainage. Our aim was to determine the efficacy of our Fontan management protocol in reducing chest tube drainage and length of stay.
  
  
  METHODS
  Patients who underwent a Fontan procedure at our institution from June 2008 to September 2013 were analyzed (n = 42). We currently manage our patients according to the PORTLAND protocol: Peripheral vasodilation, Oxygen, Restriction of fluids, Technique of surgery, Low-fat diet, Anticoagulation (including antithrombin III management), No ventilator, and Diuretics. Group A (n = 28) had surgery prior to initiation of this protocol; group B (n = 14) had surgery during the current protocol era.
  
  
  RESULTS
  The median number of chest tube days was lower in group B (6 vs 11 days, p < 0.001) as was the total indexed drainage (126 vs 259 mL/kg, p < 0.001). Patients in group B had shorter intensive care unit length of stay (4 vs 7 days, p = 0.004) and hospital length of stay (8 vs 13 days, p = 0.001). Group B had higher preoperative common atrial pressures (7.0 vs 5.8 mm Hg, p = 0.017), end-diastolic pressures (9 vs 7 mm Hg, p = 0.026), and trended toward higher pulmonary artery pressures (11.5 vs 9.5 mm Hg, p = 0.077). There was no statistically significant difference in age, weight, transpulmonary gradient, or pulmonary vascular resistance between groups.
  
  
  CONCLUSIONS
  The PORTLAND protocol has improved early outcomes after the Fontan procedure. Chest tube drainage and duration, and both intensive care unit and hospital length of stay have been reduced since initiation of this protocol.
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon. Electronic address: sunstrom@ohsu.edu.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Sunstrom
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Ashok
authors.initials: A
authors.lastname: Muralidaran
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Rabin
authors.initials: R
authors.lastname: Gerrah
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Reed
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Milon K
authors.initials: MK
authors.lastname: Good
authors.affiliation: Division of Pediatric Cardiology, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Laurie R
authors.initials: LR
authors.lastname: Armsby
authors.affiliation: Division of Neurologic Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Rekito
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: M Mujeeb
authors.initials: MM
authors.lastname: Zubair
authors.affiliation: Division of Pediatric and Congenital Cardiac Surgery, Doernbecher Children's Hospital, Oregon Health and Science University, Portland, Oregon.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Langley
mesh_terms: D015505:Chest Tubes; D002675:Child, Preschool; D002985:Clinical Protocols; D004322:Drainage; D018729:Fontan Procedure; D006801:Humans; D007902:Length of Stay; D011182:Postoperative Care; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome