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Noninvasive ventilation can avert ARF for most ICU cancer patients with ARF. For patients with pulmonary infections and high severity scores, NIV should be used with caution. Identifying risk factors for NIV failure using a comprehensive diagnostic approach and monitoring of NIV are paramount to improve outcomes.

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Rev Med (São Paulo DESCRITORES:Ventilação não invasiva; Doença pulmonar obstrutiva crônica; Ventiladores mecânicos. ABSTRACT: Noninvasive ventilation (NPPV) is frequently used inChronic Obstructive Pulmonary Disease (COPD). The aim of this study is to compare the performance of three NPPV interfaces in terms of patient-ventilator synchrony. We used a lung simulator attached to a mannequin head to simulate a COPD patient on NPPV. Three interfaces with inner volumes of 366, 550 and 1500 mL were tested. Results showed that the interface with larger inner volume had higher air leakage, while smaller inner volume interfaces had better synchrony with the simulator, with shorter trigger delay (131 e 128ms vs 153ms) and faster flow acceleration (138 e 143ms vs 161ms). We conclude that the type of interface used for NPPV has an impact on synchrony, and the choice of the interface may be based on the need to or unload respiratory muscles.

Introduction. The aim of this preliminary work is to analyze the clinical features of 52 patients with a functional transplanted kidney for >25 years (all first transplant and all deceased donor recipients) and to compare with a similar though more complete study from Hôpital Necker-Paris 2012. Methods. The mean graft survival at 25 years is 12.7% and at 30 years is 10%. The actual mean serum creatinine concentration is 1.3 mg/L. We analyzed recipient age (mean, 35.9 years) and gender (29 men and 23 women). Donor age was 26.7 AE 10.3 years. Seven patients (13.4%) were transplanted with 1 HLA mismatch, 42.3% with 2 mismatches, and 44.2% with 3 mismatches. Mean cold ischemia time was 15.45 AE 7.7 hours. Of the recipients, 76% had immediate graft function; 38% experienced 1 acute rejection episode and 4 patients had 2 rejection crises. The initial immunosuppressive regimen was azathioprine (AZA) þ prednisolone (Pred) in 14 patients, cyclosporin (CSA) þ Pred in 13 patients, and CSA þ AZA þ Pred in 25 patients. Of these patients, 19% maintained their initial regimen, and 54% (28 patients) were very stable on a mixed CSA regimen for >25 years.Results. We present the major complications (diabetes, neoplasia, and hepatitis C virus positivity). Conclusion. Our results in deceased donor kidney recipients for >25 years are similar to the mixed population (deceased donors and living donors) presented by the Necker group, although 54% of our patients remain on CSA immunosuppression, contradicting the idea that its use is not compatible with good long-term kidney function in transplant recipients.C ONSIDERABLE progress has been made in the care of transplant recipients regarding organ preservation, quality, and quantity for life of these patients. Mainly, improvements in the management of complications allowed the emergence of a group of long-term survivors who were transplanted several decades ago. These patients constitute a unique population about whom few data have been published. The few publications [1e3] of patients with functioning renal allograft for >25 years are usually related to a mixed population of living-related donors (usually the larger percentage) and deceased donor transplant recipients.Our unit performed our first renal transplantation in June 1980. We celebrated our 500th in 1990 and our 1000th procedure in 1997. We selected a group of patients with functioning kidney graft transplanted !20 years ago, all from a deceased donor. The aim of the work was to present and compare the clinical characteristics of this unique population. PATIENTS AND METHODSFrom July 1980 to January 15, 1994 (20 years ago), we performed 759 transplants; of those recipients, 110 maintain a functioning kidney on follow-up, 52 for >25 years and 11 for >30 years. The longest surviving recipient has a 33-year-old, functioning graft. The

BACKGROUND: Noninvasive ventilation (NIV) reduces intubation and mortality in patients with COPD exacerbation who present with respiratory failure, and the type of mask may affect its success. Our objective was to compare the performance of 3 different NIV masks in a lung model. METHODS: We set the lung simulator mechanics and respiratory rate, and tested a small oronasal mask, a total face mask, and a large oronasal mask. We added CO 2 at a constant rate into the system and monitored the end-tidal carbon dioxide. We used a mechanical ventilator to deliver NIV in 8 different combinations of inspiratory effort, pressure support, and expiratory positive airway pressure. We measured end-tidal carbon dioxide mask leakage, tidal volume, trigger time, time to achieve 90% of the inspiratory target during inspiration, and excess inspiratory time. RESULTS: We presented the mean ؎ SD of the 8 simulated conditions for each mask. The mean ؎ SD leakage was higher for the total face mask (51 ؎ 6 L/min) than for the small oronasal mask (37 ؎ 5 L/min) and for the large oronasal mask (21 ؎ 3 L/min), P < .001; but end-tidal carbon dioxide and tidal volume were similar. The mean ؎ SD 90% of the inspiratory target during inspiration was faster for the small oronasal mask (585 ؎ 49 ms) compared with the large oronasal (647 ؎ 107 ms) and total face mask (851 ؎ 105 ms), P < .001, all other variables were similar. CONCLUSIONS: In this model, we found that the type of mask had no impact on CO 2 washout or on most synchrony variables.

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