Our results suggest that building trauma centers and establishing a massive transfusion protocol according to the specific situations of a country will help improve outcomes for major trauma patients, even in developing countries without a well-established trauma system.

We suggest that ET should be considered in trauma patients needing prolonged mechanical ventilation. Also, we recommend that surgeons perform tracheostomy as early as within 7 days after intubation to not only reduce the ventilation and ICU days but also prevent pneumonia without worrying about an increase in postoperative complications.

AimTo evaluate the CVC-related infection rate according to catheter insertion site and to analyze the risk factors for catheter-related local infections (CRLI) and bloodstream infections (CRBSI) among severe trauma patients.MethodsWe reviewed the medical records of 736 severe trauma patients with an Injury Severity Score of >15. Poisson regression was used to compare the infection rates according to the catheter insertion sites. Univariate analysis of the groups with and without CVC-related infection was used to identify confounding variables for inclusion in multivariate models that were used to identify the risk factors for CRLI and CRBSI.ResultsWe evaluated 1646 catheter insertions and their duration of insertion and found 1241 subclavian (18,461 days), 251 internal jugular (3454 days), and 154 femoral catheters (1526 days). The CRLI infection rate per 1000 catheter days was significantly lower for subclavian, compared to that for internal jugular (4.83 vs. 9.55, respectively; P < 0.001) and femoral catheters (4.83 vs. 7.93, respectively; P = 0.013). Multivariate logistic regression analysis revealed that catheter insertion duration [odds ratio (95 % confidence interval): 1.035 (1.021–1.050), P < 0.001] and subclavian access [0.532 (0.366–0.775), P < 0.001] were significantly associated with CRLI, while catheter insertion duration [1.024 (1.002–1.046), P = 0.032] was significantly associated with CRBSI.ConclusionsTo reduce the rate of CVC-related infections in severe trauma patients, we suggest that catheters be shifted from the internal jugular or femoral veins to the subclavian vein as soon as possible and that the duration of catheter insertion should be minimized.

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