Surfactant Therapy for COVID-19 Related ARDS: A Retrospective Case-Control Pilot Study.

Abstract

Background. COVID-19 causes acute respiratory distress syndrome (ARDS) and depletes the lungs of surfactant, leading to prolonged mechanical ventilation and death. The feasibility and safety of surfactant delivery in COVID-19 ARDS patients have not been established. Methods. We performed retrospective analyses of data from patients receiving off-label use of natural surfactant during the COVID-19 pandemic. Seven COVID-19 PCR positive ARDS patients received liquid Curosurf (720 mg) in 150 ml normal saline, divided into five 30 ml aliquots) and delivered via a bronchoscope into second-generation bronchi. Patients were matched with 14 comparable subjects receiving supportive care for ARDS during the same time period. Feasibility and safety were examined as well as the duration of mechanical ventilation and mortality. Results. Patients showed no evidence of acute decompensation following surfactant installation into minor bronchi and lung retention for up to 2 hours. Cox regression showed a reduction of 28-days mortality within the surfactant group, though not significant. The surfactant did not increase the duration of ventilation, and health care providers did not convert to COVID-19 positive. Conclusions. Surfactant delivery through bronchoscopy at a dose of 720 mg in 150 ml normal saline is feasible and safe for COVID-19 ARDS patients and health care providers during the pandemic. Surfactant administration does not cause acute decompensation, and it could be related to improved survival and reduction of mechanical ventilation duration. This study supports the future performance of randomized clinical trials evaluating the efficacy of meticulous surfactant delivery.

Use of exogenous pulmonary surfactant in acute respiratory distress syndrome (ARDS): Role in SARS-CoV-2-related lung injury

“…Although the study showed how there is no evidence of acute decompensation after the installation of surfactants and mortality has shown 28 days; there were no acute effects decompensation on patients treated ( Piva et al, 2021 ). The data are still preliminary and limited.…”

“…Some of these studies support its use however, otherhave shown that there is no significant improvement. Nine articles were found to support the clinical efficacy of the exogenous surfactant in inflammatory lung diseases: i) Two of them are pre-clinical trials on animals (rabbits and lambs) ( Zebialowicz Ahlström et al, 2019 ; Van Zyl and Smith, 2013 ); ii) three describe clinical trials on infants and children, two of which are meta-analyses ( Chakraborty and Kotecha, 2013 ; More et al, 2014 ) and a comparative study ( Liu et al, 2017 ); iii) three are meta-analyses ( Meng et al, 2012 , 2019 ; Zhang et al, 2013 ) describing the results obtained from several randomized clinical trials on adults; iv) one article is a retrospective case-control pilot study ( Piva et al, 2021 )…”

“…A recent retrospective study investigated the feasibility, efficacy and safety of off-label use of Curosurf on COVID-19 positive ARDS adult patients as well as duration of mechanical ventilation and mortality ( Piva et al, 2021 ).…”

“…The data are still preliminary and limited. Further randomized clinical trials are needed ( Piva et al, 2021 ).…”

Phospholipids dock SARS-CoV-2 spike protein via hydrophobic interactions: a minimal in-silico study of lecithin nasal spray therapy

“…a significant potential for short-term prevention and therapeutic application for respiratory virus infection [34]. Moreover, the role of the pulmonary surfactant has been highlighted and proposed as a potential treatment approach even for severe cases of COVID-19 [88,89,90,91,92]. All in all, the manner in which surfactants are able to alter and mediate the interactions of viral proteins in the cell offers many interesting and promising possibilities and improve our understanding of the interaction between phospholipids and receptor-binding motif of SARS-CoV-2 at the nanoscale.…”