Abstract
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.
 Key words: Helmet CPAP; ARDS; COVID-19; Tocilizumab; Cytokine storm
 Citation: Permana SA, Sugiarto A, Thamrin MH, Arifin, Harsini. A promising therapy of tocilizumab and helmet CPAP to prevent intubation for COVID-19 induced severe ARDS: a case report. Anaesth. pain intensive care 2020;24(6):659-663; DOI: 10.35975/apic.v24i6.1409
 Received - 17 September 2020, Reviewed – 01 October 2020, Accepted – 6 November 2020
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