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Objective: to verify whether the use of invasive mechanical ventilation (IMV) with positive pressure predisposes to the appearance of acute kidney injury (AKI) in critically ill patients. Method: prospective cohort of quantitative approach developed in intensive care unit (ICU) of a public hospital. Eligible patients were selected by convenience sampling. For data collection, a questionnaire consisting of items on clinical and laboratory variables was applied. The information was extracted from the medical records during a period of 15 days. Data analysis was descriptive and inferential. Significant results with p≤0.05 were considered significant. Results: hypertension was among the most incident comorbidities (29. 1%) of the 79 patients evaluated. Among the patients analyzed, 59.5% required IMV with PEEP ≥10 cmH 2 O. Of the total number of patients, 91. 1% evolved with renal dysfunction, according to the KDIGO classification. As an outcome, 34.2% of patients died. Patients who used PEEP >5 cmH 2 0 showed significant predisposition to renal dysfunction (p≤0.05). Conclusion: invasive mechanical ventilation with positive pressure (PEEP) was a factor that contributed to aggravate renal function in different gradations. It was found that patients receiving IMV with PEEP >5 cmH 2 O are more predisposed to the onset of AKI in the ICU, due to the tendency to advanced age, overweight, long time of mechanical ventilation and also hypertension.

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A.V.S., 57-year-old, had delayed motor development milestones, walking at the age of three with slow progression of symptoms which later stabilized. At the age 31 he noticed a new worsening, with proximal lower limbs weakness and the need for unilateral support while walking. He reports a history of Poliomyelitis. Neurological examination showed thoracic kyphosis and lumbar hyperlordosis, flaccid areflex and asymmetric tetraparesis predominantly in lower limbs (worse on the left side) and proximally in upper limbs. He also had muscle atrophy on those sites with fasciculations and a pawing gait. The hypothesis of Spinal Muscular Atrophy (SMA) was raised. The electroneuromyography identified chronic severe denervation in L3-S2 and moderate in C5-C7 myotomes. Thighs and legs magnetic resonance imaging identified liposuction in the anterior, posterior and lateral compartments bilaterally with myoedema. A gene panel testing showed no variants that would justify the case. Considering the asymmetry as well as its evolution and the possible infection by Poliomyelitis, we considered the hypothesis of Post-Poliomyelitis Syndrome (PPS) to be more likely, admitting SMA with lower limbs predominance as a differential diagnosis. Poliomyelitis was a prevalent disease during pre-vaccination era and is currently restricted to surviving patients who may present a phenomenon of progression after years of stability, triggered by overtraining with dysfunction of motor neurons, recognized as PPS, with impairment of functionality. There are few reports of muscle imaging in PPS that could be crucial for investigation of atypical cases and a potential marker of progression and natural history of the syndrome.