Abstract
Coronavirus disease-2019 (COVID-19) is a highly spread infectious disease around the world. This infectious disease impacts whole body systems, specifically on respiratory system. This 57-year-old women had diagnosed COVID-19 positive and progress to acute respiratory distress syndrome (ARDS) within 1 week. Mechanical ventilation with protective lung strategy, prone position could not reverse the worsen hypoxemia and bilateral lung infiltration. Recruitment manoeuvre was proceeded with 40-40 strategy and protective/ventilation tool (P/V tool). After 4 days (8 rounds) of recruitment manoeuvre, oxygenation level and lung compliance showed dramatic improvement. The patient was finally extubated at COVID-19 Day 40 and discharged with long term oxygen use at COVID-19 Day 60. In this case, we report how recruitment manoeuvre can improve severe hypoxemia and bilateral lung infiltration dramatically in ARDS.