Bundling Procedures in Critically Ill Trauma Patients: Should It Be Done?

Area of Science:

• Trauma Surgery
• Critical Care Medicine
• Emergency Medicine

Background:

• The COVID-19 pandemic increased the practice of bundling lines in intubated patients.
• Immediate bundled lines (IBL) involve placing central venous catheters (CVC) and arterial lines (AL) within 4 hours of intubation.
• The study investigates the impact of IBL on trauma patients.

Purpose of the Study:

• To examine the effect of immediate bundled lines (IBL) on traumatic injuries.
• To determine if severely injured patients benefit from IBL.
• To identify predictors of IBL in intubated trauma patients.

Main Methods:

• Retrospective review of intubated trauma patients (January 2015 - December 2020).
• Exclusion criteria: patients under 18, those who died before ICU admission, or were transferred.
• IBL defined as CVC and AL placement within 4 hours of intubation; delayed lines >4 hours.

Main Results:

• 728 patients were analyzed; 17.7% received delayed lines.
• Severe head injury, gunshot wounds (GSW), and blood transfusions were associated with IBL.
• IBL correlated with lower Glasgow Coma Scale (GCS) and higher Injury Severity Score (ISS).

Conclusions:

• Certain trauma mechanisms (GSW, pedestrian struck), blood transfusions, and severe ISS predict IBL.
• IBL did not show superiority over immediate AL or no lines regarding mortality.
• No significant effect of lines on ICU or hospital length of stay (LOS), except for severe head injury.