Coronavirus Disease 2019 (COVID‐19) is a public health emergency of international concern with increasing cases globally, including in Indonesia. COVID‐19 clinical manifestations ranging from asymptomatic, acute respiratory illness, respiratory failure that necessitate mechanical ventilation and support in an intensive care unit (ICU), to multiple organ dysfunction syndromes. Some patients might present with happy hypoxia, a condition where patients have low oxygen saturations (S pO2 < 90%), but are not in significant respiratory distress and often appear clinically well, which is confusing for the doctors and treatment strategies. Most infections are mild in nature and have a relatively low case fatality rate (CFR); however, critical COVID‐19 patients who need support in ICU have high CFR. We would like to report a case of happy hypoxia in a critical COVID‐19‐positive ICU hospitalized patient who survived from Indonesia.

We have read with great interest the articles regarding cutaneous manifestations in Coronavirus Disease 2019 (COVID-19) infection. Studies showed 20.4% of COVID-19 patients developed cutaneous manifestations. COVID-19 causes vascular endothelial injury, vasculitis and prothrombotic state which might be the underlying cause of hemorrhagic cutaneous manifestations, disseminated intravascular coagulation (DIC), and multiple organ failures. To date, hemorrhagic cutaneous manifestations reported are chilblain-like lesion, purpura to ecchymosis, livedo reticularis, and dry gangrene. We present a case of ecchymosis in COVID-19-positive ICU hospitalized patient.

Background: Severe manifestation of COVID-19 are identical with significant inflammation and associated with high mortality due to severe hypoxemia. Bronchoscopy’s role in the management of COVID-19 patients is still controversial and minimally evaluatedCase presentation: Our case series reported unique bronchoscopy presentation. Three patients with COVID-19 were confirmed by PCR nasophryngeal swab suddenly complain of progressive dyspnea and impending respiratory failure not respond with oxygen therapy. An emergency bronchoscopy was performed. All three patient had a normal bronchial wall without inflammation and edema but showed significant thick and copious mucus plug resulting in sudden desaturation. Patient showed significant clinical improvement following bronchoscopy intervention showed by clinical and chest x-ray improvement. Conclusion : Deteriorating severe COVID-19 patient can have normal bronchial mucosa in bronchoscopy and showed marked thick and copious mucus plug. Bronchial washing and suction can be a life-saving modality as therapeutic effort. Significant improvements following the bronchial washing and suction was seen. Bronchoscopy should be performed with precaution and sufficient personal protective equipment to prevent infection transmission.

Coronavirus disease 2019 (COVID-19) is a public health emergency caused by SARS-CoV-2. A few studies reported pneumothorax in patients with COVID-19. Pneumothorax is associated with an increased morbidity and mortality. Hence, it should be considered during the treatment and follow-up of patients with COVID-19. Herein, we reported four cases of pneumothorax in critical COVID-19 patients hospitalized in the ICU and treated with a mechanical ventilation. All patients were diagnosed with COVID-19, type 1 respiratory failure, and acute respiratory distress syndrome. All patients developed pneumothorax during mechanical ventilation, although the ventilator settings were set to lung-protective strategy.

Pneumonia merupakan sepuluh besar kasus rawat inap dengan tingkat kematian 7,6%. Pneumonia dengan sepsis membutuhkan terapi suportif dan perawatan intensif karena tingkat kematian tinggi. Untuk memperbaiki kualitas perawatan dan hasil terapi yang lebih baik, perlu pengkajian dini diagnostik maupun prognostik. Prokalsitonin (PCT) dan Interleukin-6 (IL-6) merupakan penanda infeksi berat dan sepsis. Tujuan penelitian ini untuk menganalisa apakah PCT dan IL-6 dapat digunakan bersama-sama untuk menentukan prognosis pasien pneumonia dengan sepsis dalam hubungannya dengan status mortalitas pada hari ke-30. Penelitian kohort dilakukan pada Oktober 2018 dilakukan di Rumah Sakit Saiful Anwar, Malang, melibatkan 40 pasien pneumonia dengan sepsis tanpa diabetes, kanker, HIV dan kehamilan. Sequential Organ Failure Assesment (SOFA) score dihitung dan sampel darah diambil pada hari ke-0 dan ke-5 perawatan untuk mengukur kadar PCT dan IL-6. Status mortalitas pasien dilihat pada hari ke-30 sejak masuk rumah sakit. Dari 40 pasien, 23 pasien hidup (57,5%) dan 17 pasien meninggal (47,5%). Perbandingan antara kelompok hidup dan meninggal menunjukan perbedaan bermakna dan secara signifikan berhubungan dengan mortalitas pada SOFA score hari ke-5 (p&lt;0,001; OR: 78,75, CI 95% (9,948-623,414)), kadar IL-6 hari ke-5 (p&lt;0,05; OR: 9,208, CI 95% (2,146-39,521)) dan kadar PCT hari ke-5 (p&lt;0,05; OR: 4,190, CI 95% (1,104-15,901)). Hasil uji regresi logistik, didapatkan bahwa IL-6 hari ke-5 dan SOFA score hari ke-5 dapat digunakan sebagai faktor prognostik mortalitas pasien pneumonia dengan sepsis hari ke-30, artinya SOFA score diatas 6 dan kadar IL-6 diatas 332pg/mL pada hari ke-5, merupakan faktor penting dari kematian pasien (AUC: 0,935).