Multidisciplinary management of adult patients with chylothorax: a consensus statement.

Najib Rahman, Uzair K Ghori, Heather Davis, Kush Desai, Ravindra M Mehta, Andrew Kaufman, Robert Lentz, Horiana Grosu, Vivian Bishay, David J Feller-Kopman, Brian Currie, Eihab O Bedawi, Erin A Gillaspie, Janani S Reisenauer, Ajinkya Desai, Gregory Nadolski, Moishe Liberman, Udit Chaddha, Abhinav Agrawal, Fabien Maldonado, Samira Shojaee, Yaron Gesthalter, Jeffrey Forris Beecham Chick, Mark K Ferguson, Y C Gary Lee, Kazuhiro Yasufuku, Malcolm M DeCamp, K Pallav Kolli

Journal: The European respiratory journal 2024;64(5):

PMID: 39326915

Abstract

The management of chylothorax remains challenging given the limited evidence and significant heterogeneity in practice. In addition, there are no practical guidelines on the optimal approach to manage this complex condition. We convened an international group of 27 experts from 20 institutions across five countries and four specialties (pulmonary, interventional radiology, thoracic surgery and nutrition) with experience and expertise in managing adult patients with chylothorax. We performed a literature and internet search for reports addressing seven clinically relevant PICO (Patient, Intervention, Comparison and Outcome) questions pertaining to the management of adult patients with chylothorax. This consensus statement, consisting of best practice statements based on expert consensus addressing these seven PICO questions, was formulated by a systematic and rigorous process involving the evaluation of published evidence, augmented with provider experience. Panel members participated in the development of the final best practice statements using the modified Delphi technique. Our consensus statement aims to offer guidance in clinical decision making when managing patients with chylothorax while also identifying gaps in knowledge and informing future research.

Copyright ©The authors 2024. For reproduction rights and permissions contact [email protected].

Address: Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA [email protected].; Contributed equally as joint first authors.; Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Contributed equally as joint first authors.; Division of Allergy, Pulmonary and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.; University of Pennsylvania, Philadelphia, PA, USA.; University of Montreal, Montreal, QC, Canada.; University of Western Australia, Perth, Australia.; Oxford Respiratory Trials Unit, University of Oxford, Oxford, UK.; Mayo Clinic, Rochester, MN, USA.; University of Chicago, Chicago, IL, USA.; Division of Cardiothoracic Surgery, University of Wisconsin, Madison, WI, USA.; Creighton University Medical Center, Omaha, NE, USA.; Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.; New York-Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA.; Pulmonary and Critical Care Medicine, Darmouth-Hitchcock Medical Center, The Geisel School of Medicine at Dartmouth, Hanover, NH, USA.; University of Mississippi Medical Center, Jackson, MS, USA.; Division of Thoracic Surgery, Toronto General Hospital, University Health Network, University of Toronto, Toronto, ON, Canada.; Icahn School of Medicine at Mount Sinai, New York, NY, USA.; Division of Pulmonary, Critical Care, Allergy and Sleep, University of California San Francisco, San Francisco, CA, USA.; University of Texas, MD Anderson Cancer Center, Houston, TX, USA.; University of Washington, Seattle, WA, USA.; Division of Body Interventional Radiology, University of California San Francisco, San Francisco, CA, USA.; Apollo Bangalore Pulmonary Services, Apollo Hospitals Bangalore, Bangalore, India.; Northwestern University Feinberg School of Medicine, Chicago, IL, USA.; Medical College of Wisconsin, Milwaukee, WI, USA.

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