Introduction:SARS-CoV2 infection has a reported mortality of 2%, mainly due to acute respiratory distress syndrome (ARDS). Most patients with ARDS-COVID19 improve after treatment. However, some persist with respiratory failure and show fibrotic changes on High-Resolution CT (HRCT) even after support with invasive mechanical ventilation (IMV) or ECMO and corticosteroid treatment. The main objective is to evaluate the response and safety profile of antifibrotic treatment in patients with ARDS-COVID19 admitted to the Intensive Care Unit (ICU) who present fibrotic signs on chest HRCT.
Material and methods:Observational-retrospective study of patients in the ICU from March 2020 to January 2022 with ARDS-COVID19 with radiological and physiological pulmonary fibrotic signs.
Results:From 482 patients who required respiratory support, 59 were included. The mean age was 58.6. 56 patients required IMV. All had severe respiratory failure at the time of the chest HRCT with a median SaFi(Sa02/Fi02) of 194(IQR 87.6). Fibrotic signs on chest HRCT were identified 36 days(21.3 IQR) from admission, and most received treatment with steroids (91.5%). 42 patients received Pirfenidone. The mortality rate was 21.4% and was similar between groups, although patients treated with Pirfenidone had lower SaFi at hospitalization, more days on IMV and tracheostomy. No serious adverse events associated with Pirfenidone were observed, considering that in 80.9% of the cases was administered through a nasogastric tube. Only 3 patients discontinued the antifibrotic due to hepatotoxicity.
Conclusions:The use of Pirfenidone in patients with pulmonary fibrotic changes due to ARDS-COVID19 is safe. We need more studies to prove clinical benefits.