A 71-year-old male patient with prior history of hypertension, type II diabetes mellitus, and chronic kidney disease was admitted to the Hospital e Pronto-Socorro Delphina Rinaldi Abdel Aziz, a referral unit for the treatment of patients with COVID-19 in Manaus. The patient was transferred from another hospital, where he had already been diagnosed with COVID-19 by RT-qPCR. Upon admission into the ICU, he was placed under orotracheal intubation, received high-dose vasoactive drugs, was hemodynamically unstable, and presented cyanosis and cold extremities. He was administered high-flow norepinephrine (1.41 µg/kg/min) and placed on invasive mechanical ventilation under aspiration of an orotracheal tube with high parameters (positive end-expiratory pressure [PEEP] 8/FiO2 60%/respiratory rate 26; volume 360). The PaO2/FiO2 ratio was 86.6. The patient received oseltamivir (75 mg twice daily) and chloroquine (450 mg twice on the first day) via a nasoenteral tube, IV azithromycin (500 mg/day), IV ceftriaxone (2g/day), IV furosemide (20mg TID), and prophylactic subcutaneous enoxaparin (40 mg/day). No corticosteroid drugs were used.