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      Happy hypoxia in critical COVID‐19 patient: A case report in Tangerang, Indonesia

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          Abstract

          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.

          Abstract

          COVID‐19 clinical manifestation ranges 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 be presented with happy hypoxia which is confusing for the doctors and treatment strategies. We would like to report a case of happy hypoxia in a critical COVID‐19‐positive ICU hospitalized patient who survived from Indonesia.

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          Most cited references16

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          Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia

          Abstract Background In the recent outbreak of novel coronavirus infection in Wuhan, China, significantly abnormal coagulation parameters in severe novel coronavirus pneumonia (NCP) cases were a concern. Objectives To describe the coagulation feature of patients with NCP. Methods Conventional coagulation results and outcomes of 183 consecutive patients with confirmed NCP in Tongji hospital were retrospectively analyzed. Results The overall mortality was 11.5%, the non‐survivors revealed significantly higher D‐dimer and fibrin degradation product (FDP) levels, longer prothrombin time and activated partial thromboplastin time compared to survivors on admission (P < .05); 71.4% of non‐survivors and 0.6% survivors met the criteria of disseminated intravascular coagulation during their hospital stay. Conclusions The present study shows that abnormal coagulation results, especially markedly elevated D‐dimer and FDP are common in deaths with NCP.
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            Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy

            In December 2019, a novel coronavirus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) emerged in China and has spread globally, creating a pandemic. Information about the clinical characteristics of infected patients who require intensive care is limited.
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              COVID-19 and Italy: what next?

              Summary The spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already taken on pandemic proportions, affecting over 100 countries in a matter of weeks. A global response to prepare health systems worldwide is imperative. Although containment measures in China have reduced new cases by more than 90%, this reduction is not the case elsewhere, and Italy has been particularly affected. There is now grave concern regarding the Italian national health system's capacity to effectively respond to the needs of patients who are infected and require intensive care for SARS-CoV-2 pneumonia. The percentage of patients in intensive care reported daily in Italy between March 1 and March 11, 2020, has consistently been between 9% and 11% of patients who are actively infected. The number of patients infected since Feb 21 in Italy closely follows an exponential trend. If this trend continues for 1 more week, there will be 30 000 infected patients. Intensive care units will then be at maximum capacity; up to 4000 hospital beds will be needed by mid-April, 2020. Our analysis might help political leaders and health authorities to allocate enough resources, including personnel, beds, and intensive care facilities, to manage the situation in the next few days and weeks. If the Italian outbreak follows a similar trend as in Hubei province, China, the number of newly infected patients could start to decrease within 3–4 days, departing from the exponential trend. However, this cannot currently be predicted because of differences between social distancing measures and the capacity to quickly build dedicated facilities in China.
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                Author and article information

                Contributors
                catherinegunawann@gmail.com
                Journal
                Physiol Rep
                Physiol Rep
                10.1002/(ISSN)2051-817X
                PHY2
                physreports
                Physiological Reports
                John Wiley and Sons Inc. (Hoboken )
                2051-817X
                28 October 2020
                October 2020
                : 8
                : 20 ( doiID: 10.1002/phy2.v8.20 )
                : e14619
                Affiliations
                [ 1 ] Siloams Hospital Kelapa Dua Tangerang Indonesia
                [ 2 ] Faculty of Medicine Pelita Harapan University Tangerang Indonesia
                Author notes
                [*] [* ] Correspondence

                Catherine Gunawan, Faculty of Medicine, Pelita Harapan University, Sutera Intan 1 no. 23, Alam Sutera, Tangerang 15325, Indonesia.

                Email: catherinegunawann@ 123456gmail.com

                Author information
                https://orcid.org/0000-0003-3598-2545
                https://orcid.org/0000-0001-9853-0752
                https://orcid.org/0000-0001-5261-6999
                Article
                PHY214619
                10.14814/phy2.14619
                7592488
                33112512
                ad9b0193-8eaf-447a-bf5a-a0585e50214b
                © 2020 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of The Physiological Society and the American Physiological Society

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                : 23 June 2020
                : 29 September 2020
                : 29 September 2020
                Page count
                Figures: 2, Tables: 0, Pages: 5, Words: 2760
                Categories
                Case Report
                Case Report
                Custom metadata
                2.0
                October 2020
                Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.3 mode:remove_FC converted:28.10.2020

                ards,covid‐19,dic,happy hypoxia,pulmonary intravascular coagulation

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