A defined management strategy improves early outcomes after the fontan procedure

The portland protocol

Rachel Sunstrom, Ashok Muralidaran, Rabin Gerrah, Richard Reed, Milon K. Good, Laurie Armsby, Andrew (Andy) Rekito, M. Mujeeb Zubair, Stephen M. Langley

Research output: Contribution to journalArticle

9 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)148-155
Number of pages8
JournalAnnals of Thoracic Surgery
Volume99
Issue number1
DOIs
StatePublished - Jan 1 2015

Fingerprint

Fontan Procedure
Length of Stay
Chest Tubes
Drainage
Intensive Care Units
Fat-Restricted Diet
Atrial Pressure
Antithrombin III
Mechanical Ventilators
Diuretics
Vasodilation
Vascular Resistance
Pulmonary Artery
Oxygen
Blood Pressure
Pressure
Weights and Measures

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine
  • Medicine(all)

Cite this

A defined management strategy improves early outcomes after the fontan procedure : The portland protocol. / Sunstrom, Rachel; Muralidaran, Ashok; Gerrah, Rabin; Reed, Richard; Good, Milon K.; Armsby, Laurie; Rekito, Andrew (Andy); Zubair, M. Mujeeb; Langley, Stephen M.

In: Annals of Thoracic Surgery, Vol. 99, No. 1, 01.01.2015, p. 148-155.

Research output: Contribution to journalArticle

Sunstrom, Rachel ; Muralidaran, Ashok ; Gerrah, Rabin ; Reed, Richard ; Good, Milon K. ; Armsby, Laurie ; Rekito, Andrew (Andy) ; Zubair, M. Mujeeb ; Langley, Stephen M. / A defined management strategy improves early outcomes after the fontan procedure : The portland protocol. In: Annals of Thoracic Surgery. 2015 ; Vol. 99, No. 1. pp. 148-155.
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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.",
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N2 - 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.

AB - 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.

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