TY - JOUR
T1 - A promising therapy of tocilizumab and helmet CPAP to prevent intubation for COVID-19 induced severe ARDS
T2 - A case report
AU - Permana, Septian Adi
AU - Sugiarto, Adhrie
AU - Thamrin, Muhammad Husni
AU - Arifin,
AU - Harsini,
N1 - Funding Information:
ACKNOWLEDGMENT: This study was supported by the American Cancer Association IRG-58-044-47 (to Y.Z.) and the Ohio State University Startup Fund (to Y.Z. and J.Z.). The authors declare no conflicts of interest.
Publisher Copyright:
© 2020 Faculty of Anaesthesia, Pain and Intensive Care, AFMS. All rights reserved.
PY - 2020/12
Y1 - 2020/12
N2 - A 59 yrs old male with severe ARDS due to COVID-19 infection was in life threatening 'cytokine storm'. He had also co-morbids including diabetes mellitus and hypertension. He had come from Grobogan, a red area for COVID-19. Clinical finding indicted systemic inflammatory response syndrome (SIRS) with dyspnea, tachycardia, and high fever. Laboratory tests showed raised leukocyte count, CRP, SGOT/SGPT, blood sugar, PCT, low PaO2/FiO2 ratio. RT PCR showed he was infected by COVID-19. Sputum culture showed Klebsiella infection and CXR showed bilateral pneumonia. Patient was treated with standard therapy and a combination of tocilizumab for cytokine-storm and helmet CPAP for severe ARDS. Helmet CPAP has become the first modality for COVID-19 ARDS in some countries but not in Indonesia. We chose helmet CPAP because of the cost efficient, comfortable, and easy operation compared to other modality. We chose tocilizumab because it uses a single dose. Although it is expensive, only one dose is enough and it is effective in blocking the cytokine storm. We found that helmet CPAP and tocilizumab combination in COVID-19 lead severe ARDS could be promising to prevent intubation for patients.
AB - A 59 yrs old male with severe ARDS due to COVID-19 infection was in life threatening 'cytokine storm'. He had also co-morbids including diabetes mellitus and hypertension. He had come from Grobogan, a red area for COVID-19. Clinical finding indicted systemic inflammatory response syndrome (SIRS) with dyspnea, tachycardia, and high fever. Laboratory tests showed raised leukocyte count, CRP, SGOT/SGPT, blood sugar, PCT, low PaO2/FiO2 ratio. RT PCR showed he was infected by COVID-19. Sputum culture showed Klebsiella infection and CXR showed bilateral pneumonia. Patient was treated with standard therapy and a combination of tocilizumab for cytokine-storm and helmet CPAP for severe ARDS. Helmet CPAP has become the first modality for COVID-19 ARDS in some countries but not in Indonesia. We chose helmet CPAP because of the cost efficient, comfortable, and easy operation compared to other modality. We chose tocilizumab because it uses a single dose. Although it is expensive, only one dose is enough and it is effective in blocking the cytokine storm. We found that helmet CPAP and tocilizumab combination in COVID-19 lead severe ARDS could be promising to prevent intubation for patients.
KW - ARDS
KW - COVID-19
KW - Cytokine storm
KW - Helmet CPAP
KW - Tocilizumab
UR - http://www.scopus.com/inward/record.url?scp=85099050737&partnerID=8YFLogxK
U2 - 10.35975/APIC.V24I6.1416
DO - 10.35975/APIC.V24I6.1416
M3 - Article
AN - SCOPUS:85099050737
SN - 1607-8322
VL - 24
SP - 659
EP - 663
JO - Anaesthesia, Pain and Intensive Care
JF - Anaesthesia, Pain and Intensive Care
IS - 6
ER -
