Efficacy of corticosteroids as rescue therapy for prolonged mechanically ventilated-COVID patients with suspected pulmonary fibroproliferation

BACKGROUND: COVID-ARDS is characterized by protracted course and prolonged mechanical ventilation, that may be linked to exaggerated inflammation and subsequent pulmonary fibroproliferation (PFP). The role of late corticotherapy in persistent respiratory failure following COVID-ARDS has not been thoroughly investigated and only rare data are available. In this retrospective study, we aimed to assess the efficacy of corticosteroids as rescue therapy for prolonged ventilated-COVID patients with suspected PFP.METHODS: This observational retrospective study was conducted in one French ICU and included mechanically ventilated COVID-ARDS patients admitted between March 2020 and January 2022 who received high-dose of methylprednisolone for persistent COVID-ARDS after more than ten days of mechanical ventilation. Included patients exhibit at least two out of three criteria for suspicion of PFP: low lung compliance, fibrotic changes on chest CT, or persistent hypoxemia. Endpoints were improvement of lung compliance and hypoxemia.RESULTS: Among the 443 patients admitted to the ICU during the inclusion period, only 19 patients met the above-mentioned criteria and received high-dose methylprednisolone as rescue therapy. The mean delay between intubation and methylprednisolone initiation was 19.1±5.6 days. Ten patients (53.7%) survived and were discharged from ICU and were still alive on day 90, they also showed significant improvement in both lung compliance (P=0.0324) and PaO2/FiO2 ratio (P=0.0352).CONCLUSIONS: A significant improvement in lung compliance and PaO2/FiO2 was observed under rescue corticotherapy in patients who survived. Whether this observed improvement is due to the late use of steroids, or not, is to be confirmed.