Structural flexural strengthening through material bonded to the concrete substrate

This article proposes an alternative method for the structural design of reinforced concrete elements strengthened in bending by metallic plates or fiber-reinforced polymer (FRP) bonded to the concrete substrate. It is proposed a new calculation procedure for the strengthening using thin adhered material bonded to the element surface that dispenses the iterative process generally used in the design. The proposed routine is validated by comparison with other methods. A practical example is also presented, applying the procedure to an element of a building where a load change was foreseen. As result, it was verified that the proposed procedure provides values similar to the trial-and-error method used in the FRP strengthening design. Results are also coherent with other methods available in the literature for metallic plates. Therefore, since this routine obtains similar values without using an iterative method, its applicability in the design becomes advantageous

Epidemiological determinants of Chrysomya (Diptera: calliphoridae) infestation in layer farms of Minas Gerais, Brazil

Aspects related to the epidemiology of Diptera belonging to genus Chrysomya were studied in order to determine predisposing factors for their occurrence in commercial laying hens farms from the state of Minas Gerais, Brazil. An observational, analytical and sectional survey was conducted to verify the main epidemiological determinants of infestations by Chrysomya spp. Forty-three farms were visited in 2012 and these 13 (30,23%) were infested by Chrysomya putoria, 4 (9,30%) by Chrysomya megacephala and 2 (4,65%) by Chrysomya albiceps and in 2 farms (4,65%) was not possible to identify the species of Chrysomya. The epidemiological determinants for the occurrence of infestations by Chrysomya spp. were investigated using multiple logistic regression models. Housing clustering type and its conditions were important factors involved in epidemiology of these species (OR=5.05, 95% CI = 2.66 to 9.58, p = 0.000). It was also observed that the increase of the humidity of manure leads to increase chances of infestations (OR = 1.81, 95% CI = 1.36 to 2.40, p = 0.000). The presence of the beetle “lesser mealworm” (Alphitobius diaperinus) (OR = 0.15, 95% CI = 0.067 to 0.36, p = 0.000) was characterized as a protective factor against infestations, probably due to predation behavior of the beetle. Some regions of the state were characterized as lower risk areas for Chrysomya spp. infestation as compared to other regions. Management measures, such as constant monitoring of water leaks on manure, adequate composting of dead poultry and periodic removal of manure could assist in decreasing the presence of Chrysomya spp. inside the laying houses

Experimentos demonstrativos na forma de show: formas alternativas relacionadas ao ensino de química

Experiments in the form of show discloses the chemical informally from the theatrical language, arousing curiosity and stimulating students' interest in this area. Thus, the CIRQUIM, group of undergraduate students in chemistry at the Universidade Federal de Goiás – Campus Jataí, offers presentations in the form of theater by staging a classroom where there is change of attitude of the teacher, suggesting the realization of experiments at room class. The CIRQUIM has made over 40 presentations to elementary students and middle Goiás - GO, showing experiments with visual effects and aroused the interest of viewers.Experimentos demonstrativos na forma de show divulgam a química informalmente a partir da linguagem teatral, despertando a curiosidade e incentivando o interesse dos alunos por esta área. Dessa maneira, o CIRQUIM, grupo formado por alunos de licenciatura em Química da Universidade Federal de Goiás – Campus Jataí, propõe apresentações em forma de teatro, encenando uma aula em que há mudança de atitude da professora, sugerindo a realização de experimentos em sala de aula. O CIRQUIM já realizou mais de 40 apresentações para alunos do ensino fundamental e médio de Jataí – GO, mostrando experimentos com efeitos visuais e despertando o interesse dos espectadores

Rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART): Study protocol for a randomized controlled trial

Background: Acute respiratory distress syndrome (ARDS) is associated with high in-hospital mortality. Alveolar recruitment followed by ventilation at optimal titrated PEEP may reduce ventilator-induced lung injury and improve oxygenation in patients with ARDS, but the effects on mortality and other clinical outcomes remain unknown. This article reports the rationale, study design, and analysis plan of the Alveolar Recruitment for ARDS Trial (ART). Methods/Design: ART is a pragmatic, multicenter, randomized (concealed), controlled trial, which aims to determine if maximum stepwise alveolar recruitment associated with PEEP titration is able to increase 28-day survival in patients with ARDS compared to conventional treatment (ARDSNet strategy). We will enroll adult patients with ARDS of less than 72 h duration. The intervention group will receive an alveolar recruitment maneuver, with stepwise increases of PEEP achieving 45 cmH(2)O and peak pressure of 60 cmH2O, followed by ventilation with optimal PEEP titrated according to the static compliance of the respiratory system. In the control group, mechanical ventilation will follow a conventional protocol (ARDSNet). In both groups, we will use controlled volume mode with low tidal volumes (4 to 6 mL/kg of predicted body weight) and targeting plateau pressure <= 30 cmH2O. The primary outcome is 28-day survival, and the secondary outcomes are: length of ICU stay; length of hospital stay; pneumothorax requiring chest tube during first 7 days; barotrauma during first 7 days; mechanical ventilation-free days from days 1 to 28; ICU, in-hospital, and 6-month survival. ART is an event-guided trial planned to last until 520 events (deaths within 28 days) are observed. These events allow detection of a hazard ratio of 0.75, with 90% power and two-tailed type I error of 5%. All analysis will follow the intention-to-treat principle. Discussion: If the ART strategy with maximum recruitment and PEEP titration improves 28-day survival, this will represent a notable advance to the care of ARDS patients. Conversely, if the ART strategy is similar or inferior to the current evidence-based strategy (ARDSNet), this should also change current practice as many institutions routinely employ recruitment maneuvers and set PEEP levels according to some titration method.Hospital do Coracao (HCor) as part of the Program 'Hospitais de Excelencia a Servico do SUS (PROADI-SUS)'Brazilian Ministry of Healt

Catálogo Taxonômico da Fauna do Brasil: setting the baseline knowledge on the animal diversity in Brazil

The limited temporal completeness and taxonomic accuracy of species lists, made available in a traditional manner in scientific publications, has always represented a problem. These lists are invariably limited to a few taxonomic groups and do not represent up-to-date knowledge of all species and classifications. In this context, the Brazilian megadiverse fauna is no exception, and the Catálogo Taxonômico da Fauna do Brasil (CTFB) (http://fauna.jbrj.gov.br/), made public in 2015, represents a database on biodiversity anchored on a list of valid and expertly recognized scientific names of animals in Brazil. The CTFB is updated in near real time by a team of more than 800 specialists. By January 1, 2024, the CTFB compiled 133,691 nominal species, with 125,138 that were considered valid. Most of the valid species were arthropods (82.3%, with more than 102,000 species) and chordates (7.69%, with over 11,000 species). These taxa were followed by a cluster composed of Mollusca (3,567 species), Platyhelminthes (2,292 species), Annelida (1,833 species), and Nematoda (1,447 species). All remaining groups had less than 1,000 species reported in Brazil, with Cnidaria (831 species), Porifera (628 species), Rotifera (606 species), and Bryozoa (520 species) representing those with more than 500 species. Analysis of the CTFB database can facilitate and direct efforts towards the discovery of new species in Brazil, but it is also fundamental in providing the best available list of valid nominal species to users, including those in science, health, conservation efforts, and any initiative involving animals. The importance of the CTFB is evidenced by the elevated number of citations in the scientific literature in diverse areas of biology, law, anthropology, education, forensic science, and veterinary science, among others

Mortality from gastrointestinal congenital anomalies at 264 hospitals in 74 low-income, middle-income, and high-income countries: a multicentre, international, prospective cohort study

Summary Background Congenital anomalies are the fifth leading cause of mortality in children younger than 5 years globally. Many gastrointestinal congenital anomalies are fatal without timely access to neonatal surgical care, but few studies have been done on these conditions in low-income and middle-income countries (LMICs). We compared outcomes of the seven most common gastrointestinal congenital anomalies in low-income, middle-income, and high-income countries globally, and identified factors associated with mortality. Methods We did a multicentre, international prospective cohort study of patients younger than 16 years, presenting to hospital for the first time with oesophageal atresia, congenital diaphragmatic hernia, intestinal atresia, gastroschisis, exomphalos, anorectal malformation, and Hirschsprung’s disease. Recruitment was of consecutive patients for a minimum of 1 month between October, 2018, and April, 2019. We collected data on patient demographics, clinical status, interventions, and outcomes using the REDCap platform. Patients were followed up for 30 days after primary intervention, or 30 days after admission if they did not receive an intervention. The primary outcome was all-cause, in-hospital mortality for all conditions combined and each condition individually, stratified by country income status. We did a complete case analysis. Findings We included 3849 patients with 3975 study conditions (560 with oesophageal atresia, 448 with congenital diaphragmatic hernia, 681 with intestinal atresia, 453 with gastroschisis, 325 with exomphalos, 991 with anorectal malformation, and 517 with Hirschsprung’s disease) from 264 hospitals (89 in high-income countries, 166 in middleincome countries, and nine in low-income countries) in 74 countries. Of the 3849 patients, 2231 (58·0%) were male. Median gestational age at birth was 38 weeks (IQR 36–39) and median bodyweight at presentation was 2·8 kg (2·3–3·3). Mortality among all patients was 37 (39·8%) of 93 in low-income countries, 583 (20·4%) of 2860 in middle-income countries, and 50 (5·6%) of 896 in high-income countries (p<0·0001 between all country income groups). Gastroschisis had the greatest difference in mortality between country income strata (nine [90·0%] of ten in lowincome countries, 97 [31·9%] of 304 in middle-income countries, and two [1·4%] of 139 in high-income countries; p≤0·0001 between all country income groups). Factors significantly associated with higher mortality for all patients combined included country income status (low-income vs high-income countries, risk ratio 2·78 [95% CI 1·88–4·11], p<0·0001; middle-income vs high-income countries, 2·11 [1·59–2·79], p<0·0001), sepsis at presentation (1·20 [1·04–1·40], p=0·016), higher American Society of Anesthesiologists (ASA) score at primary intervention (ASA 4–5 vs ASA 1–2, 1·82 [1·40–2·35], p<0·0001; ASA 3 vs ASA 1–2, 1·58, [1·30–1·92], p<0·0001]), surgical safety checklist not used (1·39 [1·02–1·90], p=0·035), and ventilation or parenteral nutrition unavailable when needed (ventilation 1·96, [1·41–2·71], p=0·0001; parenteral nutrition 1·35, [1·05–1·74], p=0·018). Administration of parenteral nutrition (0·61, [0·47–0·79], p=0·0002) and use of a peripherally inserted central catheter (0·65 [0·50–0·86], p=0·0024) or percutaneous central line (0·69 [0·48–1·00], p=0·049) were associated with lower mortality. Interpretation Unacceptable differences in mortality exist for gastrointestinal congenital anomalies between lowincome, middle-income, and high-income countries. Improving access to quality neonatal surgical care in LMICs will be vital to achieve Sustainable Development Goal 3.2 of ending preventable deaths in neonates and children younger than 5 years by 2030

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Ageing down-modulates liver inflammatory immune responses to schistosome infection in mice.

Ageing is associated with several alterations in the immune system. Our aim in this study was to compare the development of immunity to Schistosoma mansoni infection in young versus aged C57Bl ⁄ 6 mice using the liver as the main organ to evaluate pathological alterations and immune responses. In the acute phase, young mice had large liver granulomas with fibrosis and inflammatory cells. Chronic phase in young animals was associated with immunomodulation of granulomas that became reduced in size and cellular infiltrate. On the other hand, aged animals presented granulomas of smaller sizes already in the acute phase. Chronic infection in these mice was followed by no alteration in any of the inflammatory parameters in the liver. In concert with this finding, there was an increase in activated CD4+ T, CD19+ B and NK liver cells in young mice after infection whereas old mice had already higher frequencies of activated B, NK and CD4+ T liver cells and infection does not change these frequencies. After infection, liver production of inflammatory and regulatory cytokines such as IFN-c, IL-4 and IL-10 increased in young but not in old mice that had high levels of IL-4 and IL-10 regardless of their infection status. Our data suggest that the unspecific activation status of the immune system in aged mice impairs inflammatory as well as regulatory immune responses to S. mansoni infection in the liver, where major pathological alterations and immunity are at stage. This poor immune reactivity may have a beneficial impact on disease development

Clinical outcomes of patients requiring ventilatory support in Brazilian intensive care units: a multicenter, prospective, cohort study

André Miguel Japiassu. Fundação Oswaldo Cruz. Instituto Nacional de Infectologia Evandro Chagas. The authors would like to thank the following sites and investigators: Bahia: Hospital Espanhol - Salvador (Amadeu Martinez, Lívia Leal, Antonio Jorge Pereira). Distrito Federal: Hospital Santa Luzia - Brasilia (Marcelo de Oliveira Maia, José Aires Neto). Espírito Santo: Vitória Apart Hospital - Vitória (Claudio Piras), Centro Integrado de Atenção à Saude (CIAS) Unimed Vitória - Vitória (Eliana Bernadete Caser, Cora Lavigne Moreira), Hospital Meridional - Cariacica (Pablo Braga Gusman, Dyanne Moysés Dalcomune). Maranhão: UDI Hospital - São Luís (Alexandre Guilherme Ribeiro de Carvalho, Louise Aline Romão Gondim, Lívia Mariane Castelo Branco Reis) Minas Gerais: Hospital Madre Tereza - Belo Horizonte (Daniel da Cunha Ribeiro, Leonardo de Assis Simões, Rafaela Siqueira Campos, José Carlos Fernandez Versiani dos Anjos), Hospital Mater Dei - Belo Horizonte (Frederico Bruzzi Carvalho). Pará: Hospital Regional Público do Araguaia - Redenção (Rossine Ambrosio Alves, Lilian Batista Nunes). Paraná: Hospital do Trabalhador - Curitiba (Álvaro Réa-Neto, Mirella Cristine de Oliveira), Hospital Vita Batel - Curitiba (Álvaro Réa-Neto, Mirella Cristine de Oliveira), Hospital Universitario Cajuru - Curitiba (Álvaro Réa-Neto, Luana Tannous), Instituto de Neurologia de Curitiba (INC) - Curitiba (Álvaro Réa-Neto, Brenno Cardoso Gomes). Rio de Janeiro: Instituto Nacional de Câncer - Hospital do Câncer I - Rio de Janeiro (Vicente Cés de Souza Dantas), Hospital de Clínicas de Niterói - Niterói (Fernando Borges Rodriguez, Priscila Abelha); Hospital de Clínicas Mario Lioni - Duque de Caxias (Marcelo E. Lugarinho); Instituto de Pesquisa Clínica Evandro Chagas (IPEC) - Rio de Janeiro (Andre Japiassu), Hospital da Mulher Heloneida Studart - Rio de Janeiro (Hélder Konrad de Melo, Elton Afonso Lopes), Hospital Pasteur - Rio de Janeiro (Pedro Varaschin, Vicente Cés de Souza Dantas), Hospital São Lucas - Rio de Janeiro (Marcos Freitas Knibel, Micheli Ponte, Pedro Mendes de Azambuja Rodrigues), Hospital Pro-Cardiaco - Rio de Janeiro (Rubens Carmo Costa Filho, Felipe Saddy, Théia Forny Wanderley Castellões, Suzana Alves Silva), Nortecor Hospital de Clínica - Rio de Janeiro (Luiz Antonio Gomes Osorio, Dora Mannarino), Hospital Copa D’Or - Rio de Janeiro (Rodolfo Espinoza, Cassia Righy, Marcio Soares, Jorge Salluh, Lilian Tanaka, Daniel Aragão, Maria Eduarda Tavares, Maura Goncalves Pereira Kehdi). Roraima: Hospital Geral de Roraima - Boa Vista (Valéria Maria Campos Rezende, Roberto Carlos Cruz Carbonell). Rio Grande do Sul: Hospital Moinhos de Vento - Porto Alegre (Cassiano Teixeira, Roselaine Pinheiro de Oliveira, Juçara Gasparetto Maccari, Priscylla Souza Castro), Santa Casa de Misericórdia de Porto Alegre - Pavilhão Pereira Filho (Paula Berto, Patricia Schwarz); Santa Casa de Misericórdia de Porto Alegre - Hospital Santa Rita (André Peretti Torelly, Thiago Lisboa, Paula Berto, Edison Moraes). Santa Catarina: Hospital São José - Criciúma (Felipe Dal-Pizzol, Cristiane Tomasi Damiani, Cristiane Ritter). São Paulo: Hospital A. C. Camargo - São Paulo (Juliana Carvalho Ferreira, Ramon Teixeira Costa, Pedro Caruso); Fundação Pio XII - Hospital de Câncer de Barretos - Barretos (Cristina Prata Amendola, Amanda Maria R. R. de Oliveira, Ulysses V. A. Silva, Luciana Coelho Sanches, Rosana D. S. Almeida); Hospital Sírio Libanês - São Paulo (Luciano Cesar Azevedo, Marcelo Park, Guilherme Schettino), Hospital Israelita Albert Einstein - São Paulo (Murillo Santucci Assunção, Eliezer Silva), Hospital São Camilo Santana - São Paulo (Carlos Eduardo Barboza, Antonio Paulo Nassar Junior), Hospital São Camilo Pompéia - São Paulo (Antonio Table 4 Weaning variables of patients under invasive mechanical ventilation (Continued) Shock 20 (3) 3 (1) 17 (6) 8.86 (2.56 to 30.6) < 0.001 Ventilator-associated pneumonia 13 (2) 6 (2) 7 (3) 1.73 (0.57 to 5.21) 0.330 Dyspnea 50 (8) 31 (9) 19 (7) 0.88 (0.49 to 1.61) 0.697 Cardiac dysfunction 7 (1) 2 (0.8) 5 (2) 3.71 (0.71 to 19.3) 0.118 Hypoxemia/Hypercapnia 36 (6) 16 (5) 20 (7) 1.91 (0.97 to 3.76) 0.063 Excessive respiratory secretions 24 (4) 14 (4) 10 (4) 1.05 (0.45 to 2.40) 0.912 Azevedo et al. Critical Care 2013, 17:R63 http://ccforum.com/content/17/2/R63 Page 11 of 13 Paulo Nassar Junior), Hospital das Clinicas da Faculdade de Medicina da USP - UTI Disciplina Emergências Clinicas - São Paulo (Luciano Cesar Azevedo, Marcelo Park), Hospital das Clinicas da Faculdade de Medicina da USP - UTI Disciplina Emergências Cirurgicas - São Paulo (Paulo Fernando Guimarães Morando Marzocchi Tierno, Luis Marcelo Malbouisson, Lucas Oliveira), Hospital das Clinicas da Faculdade de Medicina da USP - UTI Disciplina Anestesiologia - São Paulo (Davi Cristovao), Hospital Ipiranga - Rede Amil - São Paulo (Manoel Leitão Neto, Ênio Rego, Fernanda Eugênia Fernandes), Hospital Do Coração - São Paulo (Marcelo Luz Pereira Romano, Alexandre Biasi Cavalcanti, Dalton de Souza Barros, Érica Aranha Suzumura, Karla Loureiro Meira, Gustavo Affonso de Oliveira), Hospital Estadual de Américo Brasiliense - Américo Brasiliense (Paula Menezes Luciano, Evelin Drociunas Pacheco), Hospital São Paulo da Universidade Federal de São Paulo - São Paulo (Bruno Franco Mazza, Flavia Ribeiro Machado, Elaine Ferreira), Hospital Universitário da Universidade de São Paulo - São Paulo (Ronaldo Batista dos Santos, Alexandra Siqueira Colombo, Antonio Carlos Nogueira, Juliana Baroni Fernandes, Raquel Siqueira Nóbrega, Barbara do C.S. Martins, Francisco Soriano), Hospital São Luiz Jardim Anália Franco - São Paulo (Rafaela Deczka Morsch, Andre Luiz Baptiston Nunes), Instituto do Câncer do Estado de São Paulo (ICESP) - São Paulo (Juliano Pinheiro de Almeida, Ludhmila Hajjar, Sílvia Moulin), Hospital e Maternidade São Luiz - Unidade Itaim - São Paulo (Fábio Poianas Giannini, Andre Luiz Baptiston Nunes).Submitted by Janaína Nascimento ([email protected]) on 2019-09-18T14:47:21Z No. of bitstreams: 1 ve_Azevedo_Luciano_etal_INI_2013.pdf: 555882 bytes, checksum: a0a647c3719bcd81efb6eb2250a9eea5 (MD5)Approved for entry into archive by Janaína Nascimento ([email protected]) on 2019-09-18T15:22:25Z (GMT) No. of bitstreams: 1 ve_Azevedo_Luciano_etal_INI_2013.pdf: 555882 bytes, checksum: a0a647c3719bcd81efb6eb2250a9eea5 (MD5)Made available in DSpace on 2019-09-18T15:22:25Z (GMT). No. of bitstreams: 1 ve_Azevedo_Luciano_etal_INI_2013.pdf: 555882 bytes, checksum: a0a647c3719bcd81efb6eb2250a9eea5 (MD5) Previous issue date: 2013Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil / Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Emergency Medicine Department. ICU. São Paulo, SP, Brazil.Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil / Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Emergency Medicine Department. ICU. São Paulo, SP, Brazil.D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.Centro de Estudos e Pesquisas em Terapia Intensiva. Curitiba, PR, Brasil.Instituto Nacional de Câncer. Hospital do Câncer I. ICU. Rio de Janeiro, RJ, Brazil / Hospital Pasteur. ICU. Rio de Janeiro, RJ, Brazil.Hospital Pasteur. ICU. Rio de Janeiro, RJ, Brazil.Centro de Estudos e Pesquisas em Terapia Intensiva. Curitiba, PR, Brasil.Universidade de São Paulo. Faculdade de Medicina. Hospital das Clínicas. Surgical Emergency Department. ICU. São Paulo, SP, Brazil.Hospital São José. ICU. Criciúma, SC, Brazil.Fundação Pio XII. Hospital de Câncer de Barretos. ICU. Barretos, SP, Brazil.Hospital São Lucas. ICU. Rio de Janeiro, RJ, Brazil.Hospital São Camilo Pompéia. ICU. São Paulo, SP, Brazil.Hospital Regional Público do Araguaia. ICU. Redenção, PA, Brazil.Hospital A. C. Camargo. ICU. São Paulo, SP, Brazil.Hospital Moinhos de Vento. ICU. Porto Alegre, RS, Brazil.Hospital Geral de Roraima. ICU. Boa Vista, RR, Brazil.Hospital Espanhol. ICU. Salvador, BA, Brazil.Hospital Estadual Américo Brasiliense. ICU. Américo Brasiliense, SP, Brazil.Hospital Sírio-Libanês. Research and Education Institute. São Paulo, SP, Brazil.D’Or Institute for Research and Education. Rio de Janeiro, RJ, Brazil.Introduction: Contemporary information on mechanical ventilation (MV) use in emerging countries is limited. Moreover, most epidemiological studies on ventilatory support were carried out before significant developments, such as lung protective ventilation or broader application of non-invasive ventilation (NIV). We aimed to evaluate the clinical characteristics, outcomes and risk factors for hospital mortality and failure of NIV in patients requiring ventilatory support in Brazilian intensive care units (ICU). Methods: In a multicenter, prospective, cohort study, a total of 773 adult patients admitted to 45 ICUs over a twomonth period requiring invasive ventilation or NIV for more than 24 hours were evaluated. Causes of ventilatory support, prior chronic health status and physiological data were assessed. Multivariate analysis was used to identifiy variables associated with hospital mortality and NIV failure. Results: Invasive MV and NIV were used as initial ventilatory support in 622 (80%) and 151 (20%) patients. Failure with subsequent intubation occurred in 54% of NIV patients. The main reasons for ventilatory support were pneumonia (27%), neurologic disorders (19%) and non-pulmonary sepsis (12%). ICU and hospital mortality rates were 34% and 42%. Using the Berlin definition, acute respiratory distress syndrome (ARDS) was diagnosed in 31% of the patients with a hospital mortality of 52%. In the multivariate analysis, age (odds ratio (OR), 1.03; 95% confidence interval (CI), 1.01 to 1.03), comorbidities (OR, 2.30; 95% CI, 1.28 to 3.17), associated organ failures (OR, 1.12; 95% CI, 1.05 to 1.20), moderate (OR, 1.92; 95% CI, 1.10 to 3.35) to severe ARDS (OR, 2.12; 95% CI, 1.01 to 4.41), cumulative fluid balance over the first 72 h of ICU (OR, 2.44; 95% CI, 1.39 to 4.28), higher lactate (OR, 1.78; 95% CI, 1.27 to 2.50), invasive MV (OR, 2.67; 95% CI, 1.32 to 5.39) and NIV failure (OR, 3.95; 95% CI, 1.74 to 8.99) were independently associated with hospital mortality. The predictors of NIV failure were the severity of associated organ dysfunctions (OR, 1.20; 95% CI, 1.05 to 1.34), ARDS (OR, 2.31; 95% CI, 1.10 to 4.82) and positive fluid balance (OR, 2.09; 95% CI, 1.02 to 4.30). Conclusions: Current mortality of ventilated patients in Brazil is elevated. Implementation of judicious fluid therapy and a watchful use and monitoring of NIV patients are potential targets to improve outcomes in this setting