Ali Dolatabadi - Academia.edu (original) (raw)

Papers by Ali Dolatabadi

Introduction: Considering the anti-inflammatory role of intravenous (IV) lidocaine, its analgesic... more Introduction: Considering the anti-inflammatory role of intravenous (IV) lidocaine, its analgesic properties, and its ability to reduce the need for opioids during and after surgery, in this study we decided to evaluate the effect of IV lidocaine infusion on levels of inflammatory factors based on neutrophil to lymphocyte ratio (NLR) in breast cancer surgery candidates. Methods: The present study is a randomized clinical trial. All the patients with ASA: I, II breast cancer, who were candidates of mastectomy elective surgery were included. The patients were allocated to 2 groups of IV lidocaine and normal saline based on a random numbers table. After inducing anesthesia similarly for all the patients, using 0.02 mg/kg midazolam, 2-4 µg/kg fentanyl, 1-2 mg/kg propofol and 0.5 mg/kg atracurium, either 1.5 mg/kg/hr IV lidocaine or the same volume of normal saline was infused intravenously. Glasgow prognostic score and NLR were calculated before and 6, 24, and 48 hours and 14 days after...

Health, 2012

Background: The role of prognosis-prediction by scoring systems is an issue of importance to decr... more Background: The role of prognosis-prediction by scoring systems is an issue of importance to decrease the mortality rate in children with trauma. In this study, our goal was to evaluate the prognosis of trauma among children younger than 17 years of age and the contributing factors in the setting of a teaching hospital. Materials and Methods: In this descriptive cross-sectional study, we evaluated 151 consecutive children, younger than 17 years of age, victims of trauma who were admitted to a teaching hospital in Tehran, Iran between November 2009 and March 2010. Results: In this study, the mean PTS was 11.04 that this variable was 7.58 in cases with morbidity which was significantly higher than non-morbid cases (P = 0.001). Conclusions: The result of our study indicates that pediatric trauma scoring system can be used as a tool to predict the prognosis of trauma in children.

Nigerian Medical Journal, 2015

Background: Rapid and proper diagnosis of sepsis is one of the daily challenges of emergency depa... more Background: Rapid and proper diagnosis of sepsis is one of the daily challenges of emergency department (ED) and intensive care units. The general aim of the present study was to determine the efficacy of measuring procalcitonin levels in the early diagnosis of bacterial resistance to antibiotics administered empirically in patients with sepsis. Materials and Methods: The present cross-sectional study consisted of patients with clinical evidence of sepsis or systemic inflammatory response syndrome (SIRS), referring to the ED of a third-level hospital in Tehran, Iran in 2012. After collection of basic and clinical data of patients, venous blood samples were taken for routine laboratory tests and determination of procalcitonin serum levels at baseline and 6 and 24 hours after administration of the first dose of an empirical antibiotic. The subjects were divided into two groups of discharged and expired and then comparisons were made using t-test, Chi-squared test and Fisher's test. Specificity and sensitivity of procalcitonin were evaluated along with ROC curve. Results: In the present study, 170 patients with sepsis were included. Evaluation of serum levels of procalcitonin 24 hours after administration of antibiotics exhibited the best sensitivity and specificity for each patient's response to antibiotics. Use of the cutoff point of 6.5 mg/mL for procalcitonin can predict the disease outcome with sensitivity and specificity of 67% and 80%, respectively. Conclusion: It is suggested that procalcitonin be used for the diagnosis of sepsis or SIRS resulting from an infectious disease, for follow-up of treatment and for evaluation of response to treatment.

Introduction: Since many years ago several problems have been felt in emergency departments (ED) ... more Introduction: Since many years ago several problems have been felt in emergency departments (ED) of hospitals. In fact, none of physicians in the hospital have accepted the direct responsibility of patients' management in the EDs and emergency wards of University centers have been managed by residents of various disciplines. Thus, the first line of therapy does not have guardian and several consultants with various specialists have been performed regarding patient's management. The necessity of physician training was noticed for the first time in 1950 and after 24 years in 1974, the academic emergency medicine was established in United States of America (USA) in response to people expectations for overnight accessibility to specialized and quality medical cares. It was performed with foundation of the first period of resident's training in emergency medicine discipline at University of Cincinnati, Ohio. At beginning, specialists of different fields such as internal medicine, surgery, anesthesia, orthopedics, and neurosurgery initiated the training of emergency medicine residents together which could be responsible to most of referees. Finally, with formal accepting the specialty board in 1978, this field has been officially identified as the 23 th discipline in USA. Today the EDs of most hospitals in European and American countries has been managing by emergency medicine specialists which leads to improve the quality of education and treatment, significantly. Also in Iran the request of establishing this major has been presented in the secretariat of the council for graduate medical education for the first time in 1996. This request was approved and principles of its initiating recognized officially by the ministry of health. But, considering to lack of an appropriate infrastructure, it postponed until 2000 that again this discipline was missioned for initiating to the council for graduate medical education by the minister and its outcome was directly declared to him. Lastly, in ministry time of Dr. Farhadi in 2001 this major was initiated for the first time in Iran University of Medical Sciences. The present report was addressed to the education guideline of emergency medicine at Shahid Beheshti University of Medical Sciences besides evaluating the formation history of emergency medicine discipline in Iran.

$Research paper thumbnail of Femoral nerve block in patients with femoral shaft fractures in emergency department$

Background: Femoral shaft fracture is a common problem in emergency departments. The aim of this ... more Background: Femoral shaft fracture is a common problem in emergency departments. The aim of this study is comparing femoral nerve block (FNB) method with morphine administration for analgesia in patients with femoral shaft fractures. Method: This randomized clinical trial was conducted in the emergency department of Imam Hossein Hospital in the year 2012 and in the patients with femoral shaft fractures and aged greater than 6 years. Patients were divided into two treatment groups: FNB and morphine groups. In FBN patients, femoral nerve block using 4mg/kg of 1% Lidocaine and 0.1mg/kg morphine administration were performed by an emergency medicine resident. Pain scores were evaluated using Visual Analog Scale (VAS) method before administration, 5 minutes, and 1, 2 and 3 hours after administration. The data was analyzed using SPSS Ver. 20. Multivariate analysis, Ttest, and chi-square were used for comparison of the variables and the level of statistical significance was considered to be p <0.05. Results: There were 59 patients in each group. The mean and standard deviation of age of the patients were 35.2±17.8 years. The onset of the methods was significantly shorter in the FNB group comparing the morphine group (2.2±6.6 vs. 4.1±1.1 min) (p<0.01). Pain scores in treatment intervals were significantly lower in the FNB group than the morphine group. The lowest pain score was observed for the interval of 1 hour in the FNB group (5.6±0.9 min). Age, gender, social habits and underlying diseases had no significant impact on the efficacy of the methods. Conclusion: The findings showed that FNB is a safe and efficacious method for pain management of femoral shaft fractures in emergency departments.

Trauma Monthly, 2013

Background: Many patients are brought to crowded emergency departments (ED) of hospitals every da... more Background: Many patients are brought to crowded emergency departments (ED) of hospitals every day for evaluation of head injuries, headaches, neurologic deficits etc. CT scan of the head is the most common diagnostic measure used to search for pathologies. In many EDs the initial interpretation of images are performed by emergency physicians (EP). Since most decisions are made based on the initial interpretation of the images by emergency physicians and not the radiologists, it is necessary to assess the accuracy of interpretations made by the former group. Objectives: The objective of this study was to compare the findings reported in the interpretation of head CTs by emergency physicians and compare to radiologists (the gold standard). Materials and Methods: This was a prospective cross sectional study conducted from March to May 2009 in a teaching hospital in Tehran, Iran. All non-contrast head CTs obtained during the study period were copied on DVDs and sent separately to a radiologist, 6 emergency medicine (EM) attending physicians and 14 senior EM residents for interpretation. Clinical information pertaining to each patient was also sent with each CT. The radiologist's interpretation was considered as the gold standard and reference for comparison. Data from EM physicians and residents were compared with the reference as well as with each other and statistical analysis was performed using SPSS 18.5. Results: Out of 544 CT scans, EM physicians had 35 false negatives and 53 false positives compared with radiologist's interpretations (P < 0.0001). EM residents had 74 false negatives and 12 false positives compared with radiologist's interpretations (P < 0.0001). Conclusions: Both EPs and ER residents either missed or falsely called a significant number of pathologies in their interpretations. The interpretations of EPs and ER residents were more sensitive and more specific, respectively. These findings revealed the need for increased training time in head CT reading for residents and the necessity of attending continuing medical education workshops for emergency physicians.

Trauma Monthly, 2014

Background: Hypertension (HTN) is a serious health problem that threatens one fourth of the adult... more Background: Hypertension (HTN) is a serious health problem that threatens one fourth of the adult population in some countries. Objectives: This study aimed to assess the prevalence and outcome of undiagnosed hypertensive patients admitted to the emergency department. Materials and Methods: This cross-sectional study was conducted from March 2009 to March 2010 at Imam Hossein Medical and Educational Center, Teheran, Iran. A total of 2070 patients aged 18 years and older were admitted to the emergency department without previous HTN history. Blood pressure was taken and repeated 10 minutes later if initial systolic blood pressure ≥ 140 mmHg or diastolic blood pressure ≥ 90 mmHg. Those who matched the inclusion criteria entered the study for further follow-up. A numerical pain score was also used for pain intensity assessment. Chi-Square and Mann Whitney U tests were performed to compare differences between sex, age and education of the participants. Results: Based on the inclusion criteria, 346 patients entered the study, out of which 168 qualified for further evaluation and follow-up. Forty eight patients (28.6%) were finally diagnosed with high blood pressure. Our study showed that the prevalence of undiagnosed HTN was 4.8%. Significant differences between blood pressure, age, pain score and education level (P < 0.001) were found. This implies that old age, poor education and low pain score are positively associated with hypertension. Conclusions: Blood pressure readings in emergency departments should not be readily attributed to pain or anxiety. Diagnosis must be based on meticulous follow-up and precise examinations.

The American Journal of Emergency Medicine, 2012

Many of critically ill patients receive medical care for prolonged periods in emergency departmen... more Many of critically ill patients receive medical care for prolonged periods in emergency department (ED). This study is the evaluation of efficiency of Acute Physiology and Chronic Health Evaluation (APACHE) III scoring system in predicting mortality rate in these patients. This study was conducted between 2008 and 2009 in Tehran, Iran. One hundred subjects were enrolled in the study. Cases were chosen from patients in need of intensive care unit (ICU) bed who were kept in the ED. The APACHE III scores and predicted and observed mortality rates were calculated using the information from patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; files, interviews with the patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; families, and performing required physical examinations and laboratory tests. The age of the patients and the ED length of stay were 66.07 (±19.92) years and 5.11 (±3.79) days, respectively. The mean (±SD) of APACHE III score of the patients was 58.89 (±18.24). The predicted mortality rate was calculated to be 32.73%, whereas the observed mortality rate was 55%. The mean (±SD) of APACHE III score of survivors and nonsurvivors was 48.63 (±16.35) and 67.63 (±14.84), respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Furthermore, the ED length of stay was 3.20 (±1.34) and 6.57 (±4.4) days in survivors vs nonsurvivors, respectively (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). The APACHE III score and ED lengths of stay were higher in this study compared with other studies. This could be ascribed to more critical patients presenting to the study center and also limited ICU bed availability. This study was indicative of applicability of APACHE III scoring system in evaluating the quality of care and prognosis of ED patients in need of ICU.

Journal of Medical Toxicology, 2012

International Emergency Nursing

As radiologic assessment is a key part in evaluating patients visited in emergency department, th... more As radiologic assessment is a key part in evaluating patients visited in emergency department, this survey was conducted to measure emergency medicine residents&amp;#39; competency in choosing appropriate diagnostic imaging in different clinical scenarios. All emergency medicine residents enrolled in an academic emergency medicine discipline in the three medical universities of Tehran, Iran were recruited. A questionnaire was designed consisting of 10 clinically common scenarios selected from the American College of Radiology appropriateness criteria. Each resident completed the survey separately with answers only given after all residents participated. 196 residents completed the survey (95% of all residents). The results were stratified by post-graduate year and university. The average number of correct answers was 6.2. First, second and third year residents scored the average of 6.1, 5.8 and 6.5, respectively (P=0.04). The average score of residents from different universities did not differ significantly. According to the low average score, it is recommended that attentive educational perfections are needed to help residents order more appropriate diagnostic images, which may also be helpful for other healthcare providers. However, it seems that our emergency medicine academic curriculum is relatively efficient to enhance residents&amp;#39; skills in choosing proper imaging.

Journal of Mazandaran University of Medical Sciences, Mar 15, 2013

Background and purpose: Hyperglycemia leads to some complications in traumatic patients and its c... more Background and purpose: Hyperglycemia leads to some complications in traumatic patients and its control could improve the patient's prognosis. In this study the prevalence of hyperglycemia and its effects were investigated in patients with multiple traumas. Materials and methods: In this cross-sectional study the blood glucose levels of 472 multiple trauma patients attending emergency department at Imam Hossein Hospital were measured in June-Oct 2010. Diabetic patients were excluded. SPSS ver.16 was applied to analyze the data. Results: The incidence of posttraumatic hyperglycemia in multiple trauma victims was 20%. There was a significant relationship between posttraumatic hyperglycemia and presence of fracture (FX). However, no significant correlation was observed between hyperglycemia and age, sex, mechanism of trauma, and site of trauma. Moreover, this study found a significant correlation between hyperglycemia and intracranial bleeding. Conclusion: Considering high rate of posttraumatic hyperglycemia and previous findings on controlling and improving the patient's prognosis, we recommend checking the blood glucose level of trauma patients` on arrival, particularly among those suspected of having FX. However, further studies are needed to investigate this issue in other traumas.

Emergency (Tehran, Iran), 2014

Quality of life (QOL) of emergency medicine specialists can be effective in providing services to... more Quality of life (QOL) of emergency medicine specialists can be effective in providing services to patients. The aim of the present study was evaluating the lifestyle of emergency medicine practitioners, understanding their problems, and addressing the solutions to enhance and improve their lifestyles, in teaching hospitals in Iran. This descriptive cross-sectional study was conducted on emergency medicine physicians in 10 teaching hospitals of Iran in 2011. Emergency physicians with at least three years of experience, who interested in the study, were enrolled in the project. All participants filled out the consent form and QOL questionnaires, and then underwent physical examinations and some medical laboratory tests. Categorical variables were reported as percentages, while continuous variables expressed as means and standard deviations. p <0.05 was considered statistically significant. Totally, 100 subjects participated in the study, of whom 48 were male. The mean and standard ...

Emergency (Tehran, Iran), 2013

Timely diagnosis and treatment of post-traumatic elevated intracranial pressure (EICP) could be r... more Timely diagnosis and treatment of post-traumatic elevated intracranial pressure (EICP) could be reduced morbidity and mortality, and improved patients' outcome. This study is trying to evaluate the diagnostic accuracy of sonographic optic nerve sheath diameter (ONSD) in detection of EICP. Sonographic ONSD of patients with head trauma or cerebrovascular accident suspicious for EICP were evaluated by a trained chief resident of emergency medicine, who was blind to the clinical and brain computed tomography scan (BCT) findings of patients. Immediately after ultrasonography, BCT was performed and reported by an expert radiologist without awareness from other results of the patients. Finally, ultrasonographic and BCT findings regarding EICP were compared. To evaluate the ability of sonographic ONSD in predicting the BCT findings and obtain best cut-off level, receiver operating characteristic (ROC) curve were used. Sensitivity, specificity, positive predictive value (PPV), negative p...

Trauma monthly, 2015

Uncontrolled hemorrhage is a well-recognized cause of mortality in trauma victims and the control... more Uncontrolled hemorrhage is a well-recognized cause of mortality in trauma victims and the control of active hemorrhage is among the initial steps in resuscitation. The purpose of this study was to assess the role of a hemostatic agent "celox" in the management of civilian stab-wound trauma. In this clinical trial study, 160 patients with penetrating limb trauma were randomly allocated to either the control or intervention group (n = 80, each group). Controls were treated with the simple pressure dressing, while the celox-coated gauze was used in the intervention group. The time for achievement of hemostasis and the amount of bleeding were recorded. Data were analyzed using SPSS Version 21 and Stata 13. A P value of less than 0.05 was considered statistically significant. The mean age of participants was 30.5 and the majority of patients were male (90.6%). The forearm and distal leg were the most sites of injury. Hemostasis was achieved within 5 minutes in 32.5% of the cont...

Chinese journal of traumatology = Zhonghua chuang shang za zhi / Chinese Medical Association, 2014

An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and e... more An accurate scoring system for intra-abdominal injury (IAI) based on clinical manifestation and examination may decrease unnecessary CT scans, save time, and reduce healthcare cost. This study is designed to provide a new scoring system for a better diagnosis of IAI after blunt trauma. This prospective observational study was performed from April 2011 to October 2012 on patients aged above 18 years and suspected with blunt abdominal trauma (BAT) admitted to the emergency department (ED) of Imam Hussein Hospital and Shohadaye Hafte Tir Hospital. All patients were assessed and treated based on Advanced Trauma Life Support and ED protocol. Diagnosis was done according to CT scan findings, which was considered as the gold standard. Data were gathered based on patient's history, physical exam, ultrasound and CT scan findings by a general practitioner who was not blind to this study. Chi-square test and logistic regression were done. Factors with significant relationship with CT scan ...

Trauma Monthly, 2015

Background: Anterior shoulder dislocation (ASD) is one of the most common reasons for referrals t... more Background: Anterior shoulder dislocation (ASD) is one of the most common reasons for referrals to emergency departments (ED). Usually, a combination of an intravenous narcotic and a benzodiazepine is used for procedural sedation and analgesia (PSA) in such cases. Objectives: This study compares the efficacy of two combinations to reduce ASD. Patients and Methods: The subjects in this clinical trial consisted of 48 patients with ASD who were randomly assigned to midazolam/ fentanyl and propofol/fentanyl groups for PSA. The two groups were compared to the time interval between injection and induction of sedation (T1), duration of time from sedation to awakening (T2), the duration of time between sedation and full awareness to time, location and individuals (T3), and possible side effects. Results: Twenty-nine subjects (60.4%) were sedated with midazolam and 19 (39.6%) were sedated with propofol. During the procedure, one patient in the propofol group experienced apnea (P = 0.39) and three patients (one in the midazolam group and two in the propofol group) experienced bradycardia (P = 0.34). The mean T1, T2, and T3 were significantly shorter in the propofol group (P < 0.001). Conclusions: It seems that propofol and fentanyl can be used as a safe and fast combination for PSA in the reduction of ASD.

Purpose: The present paper studies the effects of an educational intervention as presentation by ... more Purpose: The present paper studies the effects of an educational intervention as presentation by simulation on increasing the ability of interns in managing Dysrhythmia and performing cardiopulmonary resuscitation (CPR) Method: The present paper is studding the educational intervention on 120 interns working in the emergency department of Imam Hussein Educational Hospital. The interns were divided into two groups randomly. They were trained by two methods of showing slides and simulation. The material was the techniques of managing different types of Dysrhythmia which threaten the life such as performing CPR. The interns were tested after one month the course was finished. The tests were on subjects as interpreting Dysrhythmia, pharmacology of Dysrhythmia and clinical techniques. The data analysis was done by multivariate chi-square, t-test and logistic regression. The alpha was equal to 0.05 (Ρ<0.05) Results: The mean and standard deviation of pharmacology scores of the groups for the simulation group was 10.6±2.6 and for the slide presentation group was 0.7±2.4. (P=0.03) Conclusion: The findings indicate that there is no significant difference in training the interns by presenting slides or simulation in the performance of interns while treating Dysrhythmia.

ABSTRACT Objective: This study aimed to determine the association of cardiac risk factors and the... more ABSTRACT Objective: This study aimed to determine the association of cardiac risk factors and the risk of Acute Myocardial Infarction (AMI) in Emergency Department (ED) patients with non-diagnostic ECG changes. Methods: This cross-sectional study was conducted in the ED of Imam Hossein Hospital during a period of one year. In this study, patients with symptoms suggestive of AMI including chest pain, dyspnea, palpitation, syncope, cerebrovascular incidents, nausea, vomitting, dizziness and loss of consciousness were included. The demographic data and risk factors, such as age, gender, history of diabetes, hypertension, hyperlipidemia, renal failure, positive family history of Coronary Artery Disease (CAD), smoking, substance abuse, alcohol consumption within the past 24 hours and cocaine use within the past 48 hours were recorded. Non-diagnostic ECG included: normal, non-specific, abnormal without ischemic symptoms such as old bundle branch block, Left Ventricular Hypertrophy (LVH), etc. The final diagnosis of AMI was determined by Creatine Phosphokinase-MB (CPK-MB) serum markers and Troponin I. The data was analyzed by using SPSS v. 20 and the level of statistical significance was considered to be p< 0.05. Results: Hypertension, hyperlipidemia, family history of heart disease were significantly higher in those who had non-diagnostic ECG (p< 0.05). However, the ischemic heart diseases were significantly lower in those with non-diagnostic ECG. History of diabetes, stroke, renal failure, alcohol or opium and menopause showed no significant association with non-diagnostic or diagnostic ECG. Conclusion: Overall, the risk factors are limitedly associated with the occurrence of Myocardial Infarction (MI) in cases where ECG is not diagnostic and it is better to use other criteria to diagnose AMI.

Introduction: Quality of life (QOL) of emergency medicine specialists can be effective in providi... more Introduction: Quality of life (QOL) of emergency medicine specialists can be effective in providing services to patients. The aim of the present study was evaluating the lifestyle of emergency medicine practitioners, understanding their problems, and addressing the solutions to enhance and improve their lifestyles, in teaching hospitals in Iran. Method: This descriptive cross-sectional study was conducted on emergency medicine physicians in 10 teaching hospitals of Iran in 2011. Emergency physicians with at least three years of experience, who interested in the study, were enrolled in the project. All participants filled out the consent form and QOL questionnaires, and then underwent physical examinations and some medical laboratory tests. Categorical variables were reported as percentages, while continuous variables expressed as means and standard deviations. p <0.05 was considered statistically significant. Results: Totally, 100 subjects participated in the study, of whom 48 were male. The mean and standard deviation of the physicians' age were 38.7±5.1 years. 43% of physicians had an average QOL, while 37% good. 96% of studied physicians had a good condition regarding habitual history, while 93% of them had a poor condition in performing screening tests. Exercise program and personal health in individuals with normal BMI were correlated with higher levels of QOL. BMI was higher in 40-50 years old subjects than youth. Hypertension was present in five cases (5%), hypercholesterolemia in six (6%), hypertriglyceridemia in six (6%), increased LDL in four (4%), low HDL in four (4%), and impaired FBS in 4 (4%). Conclusion: The findings showed that 63% of studied emergency physicians had an average level of QOL and other ones good. The majority of physicians had undesirable situation regarding the performance of screening tests.

Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated ... more Introduction Community-acquired pneumonia remains a common condition worldwide. It is associated with significant morbidity and mortality. The aim of this study was to evaluate conditions that could predict a poor outcome. Design Retrospective analyse of 69 patients admitted to the ICU from 1996 to 2003. Demographic data included age, sex and medical history. Etiologic agents, multiorgan dysfunction, nosocomial infections, SAPS II and PORT scores were recorded for each patient. For statistical analysis we used a t test, chi-square test and Mann-Whitney U test on SPSS ®. A value of P less than 0.05 was considered significant. Results Forty-seven patients were male and 22 patients were female. Mean age was 52 years. Sixty-seven percent had serious pre-morbid conditions including pulmonary disease (34.8%), cardiac problems (36.2%), diabetes (13%) and chronic liver disease (5.8%); 40.6% were smokers, drug abusers or alcohol dependents. Sixtyeight patients required invasive mechanical ventilation. The average length of ventilation was 13.5 days, median 8 days. The mean SAPS II score was 40.14 and the mean PORT score was 141. The mortality rate was 27.5% (SAPS II estimated mortality, 35%). Complications reported were ARDS (40.6%), septic shock (34.8%), acute renal failure (2.9%), cardiac arrest (8.7%) and nosocomial infeccions (46.4%). Mortality rates were higher for previous hepatic (75%) and metabolic (33%) diseases. We found a close association between crude mortality and SAPS II score (P = 0.003) and development of complications (P = 0.0028). Respiratory dysfunction (P = 0.006) and septic shock (P = 0.022) were most significantly related to mortality. No significant differences were founded regarding age, comorbidities, PORT score, etiologic agents, nosocomial infections and length of invasive mechanical ventilation. Conclusions Previous hepatic chronic disease was strictly related to higher mortality as well as isolation of MRSA. ARDS and septic shock predicted a poor outcome. SAPS II score was the best severity indicator of mortality. P2 Closed endotracheal suction system without periodic change versus open endotracheal system