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A síndrome de hiperestimulação ovariana (SHEO) é uma complicação iatrogênica que ocorre na fase lútea de um ciclo hormonal induzido. Na maioria dos casos, os sintomas são autolimitados e regridem espontaneamente. Entretanto, casos graves comumente cursam com desconforto respiratório agudo. O objetivo deste estudo foi descrever a apresentação clínica, o tratamento e os desfechos de derrame pleural associado a SHEO em três pacientes submetidas a fertilização in vitro. A idade das pacientes variou de 27 a 33 anos, e o aparecimento do derrame pleural sintomático (bilateral em todos os casos) ocorreu, em média, 43 dias (variação: 27-60 dias) após o início da terapia hormonal para a indução da ovulação. Todas as pacientes necessitaram de internação hospitalar para reposição volêmica maciça, e duas delas necessitaram de ventilação mecânica não invasiva. Embora todas as pacientes tenham sido inicialmente submetidas à toracocentese, a recidiva precoce dos sintomas e do derrame pleural fez com que se optasse pela drenagem pleural com cateter do tipo pigtail. Apesar do alto débito de drenagem (média de 1.000 mL/dia na primeira semana) e do tempo de drenagem prolongado (9-22 dias), os desfechos foram excelentes (alta hospitalar). Embora o derrame pleural secundário a SHEO seja provavelmente subdiagnosticado, a morbidade associada não deve ser subestimada, principalmente devido a seus efeitos em pacientes potencialmente gestantes. Nesta série de casos, o diagnóstico precoce e as medidas de suporte clínico adequadas permitiram uma evolução favorável, limitando a abordagem cirúrgica a uma drenagem pleural adequada.

OBJECTIVES: To disseminate transesophageal ultrasound-guided fine needle aspiration (EUS-FNA) as an alternative to investigate mediastinal tumoral lesions because it is an underused modality that has been available in Brazil for more than 15 years. METHODS: Descriptive analysis of a single endoscopy service's experience since 1997 in the accomplishment of EUS-FNA for mediastinal staging of previously known malignancies (Group 1) or diagnostic definition of suspect lymph nodes and masses (Group 2). RESULTS: EUS-FNA was performed in 51 patients between 26 and 87 years of age. The diameter of the lesions ranged between 1.1 and 9.8 cm (mean 3.9 cm). Their location corresponded to the following stations: higher paratracheal (4 cases), lower paratracheal (7), aortic window (12), para-aortic (6), subcarinal (9), paraesophageal (8), and hilar (5). In Group 1, 17 patients had previously diagnosed primary lung (9), breast (4), kidney (2), colon (1), and bladder (1) cancer. Fifteen of these punctures were positive for malignity. Two others were later submitted to mediastinoscopy, which identified metastases not detected by EUS-FNA. Group 2 comprised 34 patients. Among these patients, EUS-FNA diagnosed 22 neoplasms, five cases of tuberculosis and two duplication cysts. Cytology was inconclusive or without a specific diagnosis in five other cases. Mediastinoscopy identified two undiagnosed cases of oat-cell carcinoma, one lymphoma and one cryptococcosis, and confirmed one reactive lymphadenitis. There were no complications related to the method. CONCLUSIONS: EUS-FNA obviated the need for surgical procedures in 86.3% of cases. Therefore, oncologists, pulmonologists, and thoracic surgeons should always remember the technique's potential and availability.

Visando quantificar os danos impostos a respiradores PFF-2 ao longo do tempo de uso e estimar seu período de validade na prática clínica, este estudo baseou-se na análise descritiva de máscaras cônicas do tipo PFF-2, coletadas por auxiliares de enfermagem após um, cinco, 15 e 30 dias consecutivos de uso, num hospital de referência para doenças infecciosas. Marcas de identificação pessoal foram encontradas em todos os respiradores já no primeiro dia de uso. A partir do quinto dia, todas as máscaras apresentavam sujeiras, enquanto dobraduras foram observadas em mais de 80% dos equipamentos. Manchas internas e dobras foram mais freqüentes após turnos de 12 horas do que plantões de 6 horas (p < 0.05). 16,17% das máscaras estavam extraviadas no quinto dia e 38.93% após o 30º dia de uso. O prazo de validade do respirador PFF-2, embora não seja conveniente reutilizá-lo, deve se limitar a cinco dias. With the purpose of assessing the damages to N95 respirator masks over time and to estimate their expiration after use in clinical practice, this study was based on the descriptive analysis of N95 cone-shaped masks collected by nursing assistants after one, five, 15, and 30 consecutive days of use. Personal identification marks were founds in every respirator already on the first day of use. From the fifth day onward, all masks presented some type of dirt while folds were observed in more than 80% of the devices. Internal stains and folds were more frequent among workers of the 12-hour shift in comparison to the 6-hour shift (p < 0.05). The percentage of misplaced respirators was 16.17% by day five and reached 38.93% by day thirty. Though there is no convenience in reusing N95 respirators, their expiration should not exceed 5 days of use. En la intención de cuantificar los daños impuestos a respiradores PFF-2 a lo largo del tiempo de uso y estimar su vida útil en la práctica clínica, este estudio se basó en el análisis descriptivo de máscaras cónicas del tipo PFF-2 revisadas después de uno, cinco, quince y treinta días consecutivos de uso por auxiliares de enfermería en un hospital de referencia para enfermedades infecciosas. Ya en el primer día de uso fueron encontradas marcas de identificación personal en todos los respiradores. A partir del quinto día, todas las máscaras presentaban suciedad, mientras que fueron observados pliegues en más del 80% de los equipos. Las manchas internas y pliegues fueron más frecuentes luego de turnos de 12 horas que de guardias de 6 horas (p

There is a little-noticed trend involving human immunodeficiency virus (HIV)-infected patients suspected of having tuberculosis: the triple-treatment regimen recommended in Brazil for years has been potentially ineffective in over 30% of the cases. This proportion may be attributable to drug resistance (to at least 1 drug) and/or to infection with non-tuberculous mycobacteria. This evidence was not disclosed in official statistics, but arose from a systematic review of a few regional studies in which the diagnosis was reliably confirmed by mycobacterial culture. This paper clarifies that there has long been ample evidence for the potential benefits of a four-drug regimen for co-infected patients in Brazil and it reinforces the need for determining the species and drug susceptibility in all positive cultures from HIV-positive patients.

BACKGROUND: Cases of H1N1 and other pulmonary infections evolve to acute respiratory failure and death when co‐infections or lung injury predominate over the immune response, thus requiring early diagnosis to improve treatment. OBJECTIVE: To perform a detailed histopathological analysis of the open lung biopsy specimens from five patients with ARDS with confirmed H1N1. METHODS: Lung specimens underwent microbiologic analysis, and examination by optical and electron microscopy. Immunophenotyping was used to characterize macrophages, natural killer, T and B cells, and expression of cytokines and iNOS. RESULTS: The pathological features observed were necrotizing bronchiolitis, diffuse alveolar damage, alveolar hemorrhage and abnormal immune response. Ultrastructural analysis showed viral‐like particles in all cases. CONCLUSIONS: Viral‐like particles can be successfully demonstrated in lung tissue by ultrastructural examination, without confirmation of the virus by RT‐PCR on nasopharyngeal aspirates. Bronchioles and epithelium, rather than endothelium, are probably the primary target of infection, and diffuse alveolar damage the consequence of the effect of airways obliteration and dysfunction on innate immunity, suggesting that treatment should be focused on epithelial repair.

Foram analisados retrospectivamente os registros (2000 a 2004) do Laboratório de Microbiologia do Instituto Adolfo Lutz de Santos, SP referentes a pacientes infectados pelo virus da imunodeficiência humana com suspeita de tuberculose pulmonar. Foram encaminhadas 1.321 amostras com finalidade de diagnóstico, correspondendo a 880 casos suspeitos de tuberculose em 693 pacientes. Cento e trinta e quatro baciloscopias foram positivas e em 188 culturas houve crescimento de micobactérias, correspondendo a 161 casos confirmados. Houve identificação de Mycobacterium tuberculosis em 126 (78,3%) e micobactérias não tuberculosas em 39 (24,2%). Em quatro casos, houve concomitância de Mycobacterium tuberculosis e micobactérias não tuberculosas (porém em amostras distintas). O perfil de sensibilidade às drogas antituberculose revelou 18 (14,3%) casos de resistência a pelo menos um medicamento. Estes resultados reforçam a necessidade de submeter à rotina laboratorial completa - baciloscopia, cultura com identificação e testes de sensibilidade às drogas - as amostras respiratórias de pacientes soropositivos para o vírus da imunodeficiência humana com suspeita de tuberculose para direcionamento terapêutico adequado.

BACKGROUND: Tracheostomy is electively performed in critically ill patients requiring prolonged respiratory support. The risk of transporting, the increasing associated cost and operative room schedule are some of the obstacles for wider acceptance of this procedure. The use of rigid selection criteria exclude many patients who would benefit of this approach. OBJECTIVE: To determine the safety of open bedside tracheostomy (OBT) as a routine intensive care units (ICU) procedure without any selection criteria, considering its peri and postoperative complications. METHOD: Retrospective medical chart review of all patients that underwent elective tracheostomy between April 1999 and December 2005 at ICU of three private hospitals. RESULTS: The study group comprised 552 patients with a mean age of 69.6 ± 15.8 years. The incidence of significant complications (until 30 days after the procedure) was 4.34% (24 cases): 9 minor bleeding, 9 major bleeding, 2 subcutaneous emphysema, 4 stomal infections. Late complications were: laryngotracheal stenosis in 2 and tracheoinomminate fistula in 1 patient. CONCLUSIONS: OBT seems to be a safe and simple procedure, when performed by a team of experienced physicians under controlled circumstances, and should be considered as an option for ICU patients. INTRODUÇÃO: A traqueostomia é um procedimento eletivo realizado em pacientes de unidades de terapia intensiva sob ventilação mecânica prolongada. O risco associado ao transporte, custos e dificuldades de agendamento cirúrgico são alguns obstáculos para uma maior aceitação da traqueostomia. O uso de rígidos critérios de seleção para a realização deste procedimento a beira do leito exclui muitos pacientes que se beneficiariam deste método. OBJETIVO: Determinar à segurança da traqueostomia convencional a beira do leito como procedimento de rotina (sem a utilização dos critérios de seleção) em unidades de terapia intensiva, considerando as complicações intra e pós-operatórias. MÉTODO: Revisão retrospectiva de prontuários de pacientes submetidos à traqueostomia eletiva nas unidades de terapia intensiva de três hospitais privados no período de abril de 1999 a dezembro de 2005. RESULTADOS: Foram incluídos 552 pacientes com idade media de 69.6 ± 15.8 anos. A incidência de complicações pós-operatórias (até o 30º pós-operatório) foi 4.34% (24 casos): 9 sangramentos leves, 9 sangramentos importantes, 2 enfisemas subcutâneos, 4 infecções do estoma. As complicações tardias observadas foram: estenose laringotraqueal em 2 pacientes e fistula traqueo-inominada em 1 paciente. CONCLUSÃO: A traqueostomia convencional a beira do leito parece ser um procedimento simples e seguro quando realizado por equipe experiente em condições controladas, deve, portanto ser considerada como uma opção para pacientes em terapia intensiva sob ventilação prolongada.

OBJETIVOS: Apesar de raro, o pneumotórax é um evento adverso da acupuntura potencialmente grave. Visto sua baixa freqüência, apenas relatos de casos são disponíveis e faltam informações quanto os seus aspectos clínicos e terapêuticos. O objetivo deste trabalho é avaliar apresentação clínica, tratamento e evolução do pneumotórax pós-acupuntura. MÉTODOS: Análise retrospectiva de pacientes com pneumotórax pós-acupuntura tratados em hospital terciário no período 2001 2006. RESULTADOS: Cinco pacientes (Três homens e duas mulheres) com idade média de 46 anos (30 73) foram incluídos. Com exceção de um caso em que houve pneumotórax bilateral, em todos houve perfuração pleural à esquerda. Dor torácica foi o sintoma inicial em todos os pacientes, sendo intensa em três casos, levando a procura imediata por serviço de emergência; e leve em dois casos. Quatro pacientes foram tratados com drenagem pleural (três imediatamente após a admissão e uma após falha de tratamento conservador), devido à sintomatologia exuberante e/ou volume do pneumotórax, e um paciente foi tratado conservadoramente. Todos os pacientes apresentaram evolução clínica satisfatória após resolução do pneumotórax e, em seguimento de 6 meses após o evento, apresentavam-se assintomáticos e sem alterações significativas à radiografia de tórax. CONCLUSÃO: Dor torácica ocorreu em todos os casos, em intensidade variável; a drenagem pleural foi a terapêutica mais frequentemente instituída; e todos os casos evoluíram satisfatoriamente, sem complicações.INTRODUCTION: Pneumothorax is a rare but dangerous complication of acupuncture. Because of its rarity, there are few reports in literature and, therefore little information regarding clinical and therapeutic aspects. This article aims to analyze the clinical presentation, management and follow-up of patients with pneumothorax after acupuncture. METHODS: Retrospective study of patients with post-acupuncture pneumothorax evaluated in a tertiary hospital during a five-year period (2001-2006). RESULTS: Five patients (3 male and 2 female), mean age 46 years (30 73) were included. All patients but one (who had a bilateral pneumothorax) had left-sided pneumothorax . Chest pain, which was the initial symptom in all patients was severe in three cases and mild in two. Four patients underwent tube thoracostomy (pig-tail catheter), three of them immediately after admission and the other after a failed 12-hour conservative treatment period. One patient had a successful conservative management. All had an excellent outcome and were asymptomatic and exhibited a normal chest X-ray at 6-month follow-up CONCLUSION: In all patients, the initial symptom was chest pain, of varying intensity. Tube thoracostomy was the therapeutic modality most frequently employed. All patients had a successful outcome with no further complications.

Purpose: To assess interferon gamma release assay (IGRA) and tuberculin skin test (TST) performances in the diagnosis of active tuberculosis (TB) in adults with HIV/AIDS with different degrees of immunodeficiency. Methods: Cross-sectional study conducted with 90 HIV/TB-coinfected adults, Sao Paulo, Brazil. TB diagnosis was established based on the presence of positive sputum smear, culture, or anatomic-pathological examination. The participants responded to a questionnaire and were submitted to physical examination, chest x-ray (CRX), serum CD4+ and CD8+ T cell count, TST, and IGRA (QuantiFERON®-TB Gold In Tube, Cellestis, Carnegie, Australia). Results: Characteristics of 90 HIV/TB-coinfected individuals: male (60.0%), white (54.4%), single (57.3%), and average age 39 (±10.8) years with pulmonary TB (45.6%) and average CD4+ T-cell count (198.92 cells/mm3). TST was positive in 25.56%, and IGRA was positive in 65.56%. IGRA performance was better when compared to TST (p

A girl with vertically acquired HIV infection presented with a 6-month history of dyspnea and chest pain. Computed tomography of the thorax showed a heterogenous mass measuring 13 × 9 × 17 cm located in the anterior mediastinum. Complete surgical resection was accomplished with no complications. The final diagnosis was multilocular thymic cyst, a distinct pathologic entity that is morphologically distinguishable and unrelated to congenital thymic cyst.

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigtail catheter. Despite the high output from the pleural drain (mean, 1,000 mL/day in the first week) and prolonged drainage (for 9-22 days), the outcomes were excellent: all three patients were discharged from hospital. Although pleural effusion secondary to OHSS is probably underdiagnosed, the associated morbidity should not be underestimated, especially because it affects potentially pregnant patients. In this study, early diagnosis and appropriate supportive measures yielded favorable results, limiting the surgical approach to adequate pleural drainage.

The records (2000 to 2004) of the Microbiology Laboratory of the Adolfo Lutz Institute in Santos, Brazil, were retrospectively analyzed regarding patients infected with the human immunodeficiency virus (HIV) and suspected of pulmonary tuberculosis. 1,321 samples for diagnosis purposes were selected, corresponding to 880 suspected tuberculosis cases in 693 patients. There were 134 smear-positive samples and mycobacteria growth occurred in 188 cultures, corresponding to 161 confirmed cases. Mycobacterium tuberculosis was identified in 126 (78.3%) and non-tuberculous mycobacteria in 39 (24.2%). In four cases, both Mycobacterium tuberculosis and non-tuberculous mycobacteria were simultaneously recovered from different samples. The profile of sensitivity to anti-tuberculosis drugs revealed 18 (14.3%) cases of resistance to at least one drug. These results reinforce the need to carrying out the complete laboratorial routine (sputum smear microscopy, culture and susceptibility to antituberculous drugs) for respiratory samples from human immunodeficiency virus-positive patients with suspected tuberculosis in order to direct appropriate therapy.

pelo artigo original publicado na ultima edicao de 2007 do Jornal Brasileiro de Pneumologia e compartilhamos a opiniao de que a traque-ostomia convencional a beira do leito e viavel e segura. Nossa experiencia com a tecnica e semelhante a descrita, com 4,3% de complicacoes numa amostra de 552 pacientes estudados.

Pneumothorax is a rare but dangerous complication of acupuncture. Because of its rarity, there are few reports in literature and, therefore little information regarding clinical and therapeutic aspects. This article aims to analyze the clinical presentation, management and follow-up of patients with pneumothorax after acupuncture.Retrospective study of patients with post-acupuncture pneumothorax evaluated in a tertiary hospital during a five-year period (2001-2006).Five patients (3 male and 2 female), mean age 46 years (30-73) were included. All patients but one (who had a bilateral pneumothorax) had left-sided pneumothorax . Chest pain, which was the initial symptom in all patients was severe in three cases and mild in two. Four patients underwent tube thoracostomy (pig-tail catheter), three of them immediately after admission and the other after a failed 12-hour conservative treatment period. One patient had a successful conservative management. All had an excellent outcome and were asymptomatic and exhibited a normal chest X-ray at 6-month follow-upIn all patients, the initial symptom was chest pain, of varying intensity. Tube thoracostomy was the therapeutic modality most frequently employed. All patients had a successful outcome with no further complications.

OBJETIVOS: Apesar de raro, o pneumotórax é um evento adverso da acupuntura potencialmente grave. Visto sua baixa freqüência, apenas relatos de casos são disponíveis e faltam informações quanto os seus aspectos clínicos e terapêuticos. O objetivo deste trabalho é avaliar apresentação clínica, tratamento e evolução do pneumotórax pós-acupuntura. MÉTODOS: Análise retrospectiva de pacientes com pneumotórax pós-acupuntura tratados em hospital terciário no período 2001 2006. RESULTADOS: Cinco pacientes (Três homens e duas mulheres) com idade média de 46 anos (30 73) foram incluídos. Com exceção de um caso em que houve pneumotórax bilateral, em todos houve perfuração pleural à esquerda. Dor torácica foi o sintoma inicial em todos os pacientes, sendo intensa em três casos, levando a procura imediata por serviço de emergência; e leve em dois casos. Quatro pacientes foram tratados com drenagem pleural (três imediatamente após a admissão e uma após falha de tratamento conservador), devido à sintomatologia exuberante e/ou volume do pneumotórax, e um paciente foi tratado conservadoramente. Todos os pacientes apresentaram evolução clínica satisfatória após resolução do pneumotórax e, em seguimento de 6 meses após o evento, apresentavam-se assintomáticos e sem alterações significativas à radiografia de tórax. CONCLUSÃO: Dor torácica ocorreu em todos os casos, em intensidade variável; a drenagem pleural foi a terapêutica mais frequentemente instituída; e todos os casos evoluíram satisfatoriamente, sem complicações. INTRODUCTION: Pneumothorax is a rare but dangerous complication of acupuncture. Because of its rarity, there are few reports in literature and, therefore little information regarding clinical and therapeutic aspects. This article aims to analyze the clinical presentation, management and follow-up of patients with pneumothorax after acupuncture. METHODS: Retrospective study of patients with post-acupuncture pneumothorax evaluated in a tertiary hospital during a five-year period (2001-2006). RESULTS: Five patients (3 male and 2 female), mean age 46 years (30 73) were included. All patients but one (who had a bilateral pneumothorax) had left-sided pneumothorax . Chest pain, which was the initial symptom in all patients was severe in three cases and mild in two. Four patients underwent tube thoracostomy (pig-tail catheter), three of them immediately after admission and the other after a failed 12-hour conservative treatment period. One patient had a successful conservative management. All had an excellent outcome and were asymptomatic and exhibited a normal chest X-ray at 6-month follow-up CONCLUSION: In all patients, the initial symptom was chest pain, of varying intensity. Tube thoracostomy was the therapeutic modality most frequently employed. All patients had a successful outcome with no further complications.

Pulmonary artery sarcoma is an uncommon neoplasm, and its clinical and radiological presentation usually simulates chronic thromboembolic disease. We present the case of a 77-year-old woman admitted with dyspnea, chest pain, and hemoptysis. A chest computed tomographic scan showed moderate right-sided pleural effusion and a saccular dilatation of the interlobar portion of the right pulmonary artery, which was filled with contrast and surrounded by an irregular soft-tissue attenuation mass, suggesting a ruptured pulmonary artery aneurysm. The patient was operated on. Intraoperatively, a pseudoaneurysm and a solid mass were identified within the oblique fissure around the interlobar artery. Therefore, a right pneumonectomy was performed. Definitive pathologic examination was consistent with pulmonary artery sarcoma. The patient had a good outcome and is free of disease 2 years after surgery.

Frequently, immunodeficient patients have more than one organ or system affected by opportunistic infection or neoplasia, requiring quick and precise diagnostic investigation. In some situations, different invasive diagnostic procedures may be necessary. Open lung biopsy is sometimes necessary to clarify the pulmonary diagnosis. Laparoscopy may be useful to clarify liver or other peritoneal diseases. Some specific patients might require both procedures. In this way it is proposed that the surgeon, through a microthoracotomy used for the pulmonary biopsy, has access to the diaphragm. A small phrenotomy is performed and then a liver needle biopsy under direct vision. The described technique of simultaneous open lung and hepatic biopsy permits better handling of the needle and hemostasis of the hepatic lesion at the puncture site. This method has been used since 1994 on 16 HIV-positive patients, all having clinical and laboratory manifestations of lung disease associated with liver disease of unknown etiology. No complications related to the method were observed. It is significant that different etiologies for the lung and liver disease were found in 50% of the cases. We conclude that the presented technique is simple, useful, and safe.

INTRODUÇÃO: A síndrome da imunodeficiência adquirida (AIDS) é atualmente uma pandemia, e as doenças pulmonares são a principal causa de morbidade e mortalidade dos pacientes com AIDS. Nesse sentido, as infecções respiratórias são frequente causa de hipoxemia e morte. Os pacientes com AIDS e insuficiência respiratória hipoxêmica frequentemente necessitam de ventilação mecânica invasiva, a qual é independentemente associada com mortalidade. A ventilação não invasiva com pressão positiva refere-se à oferta de assistência ventilatória mecânica sem a necessidade de invasão artificial das vias aéreas, sendo reconhecida por melhorar a oxigenação e a dispneia dos pacientes com insuficiência respiratória hipoxêmica, principalmente se aplicada de forma sequencial e progressiva, e esta pode reduzir a necessidade de ventilação mecânica invasiva nestes pacientes. Tendo em vista as incertezas quanto à resposta da oxigenação a PEEP nos pacientes com AIDS com insuficiência respiratória aguda hipoxêmica e usando o racional da pressurização progressiva das vias aéreas e seu potencial benefício na oxigenação sanguínea, nós fizemos a hipótese de que o incremento sequencial dos níveis de PEEP até 15 cmH2O pode melhorar a oxigenação sanguínea sem afetar o conforto e a hemodinâmica do paciente. O objetivo principal deste estudo foi investigar os efeitos de diferentes sequências de níveis de PEEP aplicado de forma não invasiva sobre as trocas gasosas, a sensação de dispneia e os padrões hemodinâmicos em pacientes com AIDS e insuficiência respiratória aguda hipoxêmica. O objetivo secundário foi avaliar o tempo livre de ventilação mecânica invasiva em 28 dias e a mortalidade hospitalar em 60 dias. MÉTODOS: Foram estudados 30 pacientes adultos com HIV/AIDS e insuficiência respiratória aguda hipoxêmica. Todos os pacientes receberam uma sequência randomizada de PEEP não invasivo (os valores usados foram 5, 10 ou 15 cmH2O) por vinte minutos. A PEEP foi fornecida através de máscara facial com pressão suporte (PSV) de 5 cmH2O e uma FiO2 = 1. Um período de washout de 20 minutos com respiração espontânea foi permitido entre cada PEEP. Variáveis clínicas e uma gasometria arterial foram registradas após cada etapa de PEEP. RESULTADOS: Analisando os 30 pacientes, a oxigenação melhorou linearmente com a elevação da PEEP, contudo, estudando os pacientes conforme a PEEP inicial randomizada, a oxigenação foi similar independentemente da primeira PEEP randomizada (5, 10 ou 15 cmH2O), e somente o subgrupo com PEEP inicial = 5 cmH2O melhorou mais a oxigenação quando PEEPs maiores foram usadas. A PaCO2 também aumentou junto com a elevação da PEEP, especialmente com uma PEEP = 15 cmH2O. O uso de PSV = 5 cmH2O foi associado com significante e consistente melhora da sensação subjetiva de dispnéia e da frequência respiratória com PEEP de 0 a 15 cmH2O. CONCLUSÕES: Os pacientes com SIDA e insuficiência respiratória hipoxêmica melhoram a oxigenação com a elevação progressiva e sequencial da PEEP até 15 cmH2O, contudo a elevação da PaCO2 limita a PEEP até 10 cmH2O. Uma PSV = 5 cmH2O promove uma melhora da sensação subjetiva da dispnéia independentemente do uso de PEEP INTRODUTION: The acquired immunodeficiency syndrome (AIDS) is a pandemic, and lung diseases are the leading cause of morbidity and mortality and are often associated with respiratory infections, hypoxemia and death. The noninvasive ventilation with positive pressure refers to the provision of mechanical ventilatory assistance without the need for artificial airway invasion, being recognized for improving oxygenation and dyspnea in patients with hipoxemic respiratory failure. Patients with AIDS and hypoxemic respiratory failure often require invasive mechanical ventilation, which is independently associated with mortality. Given the uncertainties about response in oxygenation with PEEP in patients with AIDS with acute hypoxemic respiratory failure and using the rational for progressive pressurization of the airway and its potential benefits on blood oxygenation, we made the hypothesis that increased levels of sequential PEEP up to 15 cmH2O may improve blood oxygenation without affecting the comfort and hemodynamics of the patient. The main objective of this study was to investigate the effects of different sequences of PEEP levels on gas exchange, the sensation of dyspnea and hemodynamics in patients with AIDS and acute hypoxemic respiratory failure. The secondary objective was to assess the time free of invasive mechanical ventilation in 28 days and hospital mortality within 60 days. METHODS: We studied 30 adults patients with HIV/AIDS and acute hypoxemic respiratory failure. All patients received a randomized sequence of noninvasive PEEP (the values used were 5,10 or 15 cmH2O) for twenty minutes. PEEP was delivered via face mask with pressure support (PSV) of 5 cmH2O and FiO2 = 1. A washout period of 20 minutes with spontaneous breathing was allowed between each PEEP trial. Clinical variables and arterial blood gases were recorded after each PEEP step. RESULTS: Analyzing the 30 patients, oxygenation improved linearly with increasing PEEP, however studying the patients randomized according to the initial PEEP, oxygenation was similar regardless of the first randomized PEEP (5,10 or 15 cmH2O), and only the subgroup with initial PEEP = 5 cmH2O further improve the oxygenation when high PEEP were used. The PaCO2 also rose beside the PEEP elevation, especially with a PEEP = 15 cmH2O. The use of PSV = 5 cmH2O was associated with significant and consistent improvement of subjective sensation of dyspnea and respiratory rate with a PEEP from 0 to 15 cmH2O. CONCLUSION: AIDS-patients with hypoxemic respiratory failure improve oxygenation with a progressive sequential elevation of PEEP up to 15 cmH2O, however the elevation of PaCO2 limit the PEEP up to 10 cmH2O. A PSV = 5 cmH2O promotes an improvement of subjective sensation of dyspnea independently from the use of PEEP