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Surfactant therapy for COVID-19 related ARDS: a retrospective case-control pilot study.
Piva, Simone; DiBlasi, Robert M; Slee, April E; Jobe, Alan H; Roccaro, Aldo M; Filippini, Matteo; Latronico, Nicola; Bertoni, Michele; Marshall, John C; Portman, Michael A.
  • Piva S; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. simone.piva@unibs.it.
  • DiBlasi RM; Department of Anaesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. simone.piva@unibs.it.
  • Slee AE; Respiratory Therapy Department, Seattle Children's Hospital, Seattle, WA, USA.
  • Jobe AH; Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA.
  • Roccaro AM; University College London, London, UK.
  • Filippini M; Perinatal Institute Cincinatti Children's Hospital, Cincinnati, OH, USA.
  • Latronico N; Children's Hospital of Cincinnati, Cincinnati, OH, USA.
  • Bertoni M; University of Cincinatti, Cincinatti, OH, USA.
  • Marshall JC; Clinical Research Development and Phase I Unit ASST Spedali Civili Di Brescia, Brescia, Italy.
  • Portman MA; Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy.
Respir Res ; 22(1): 20, 2021 Jan 18.
Article in English | MEDLINE | ID: covidwho-1067232
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 exogenous 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. 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 did not cause acute decompensation, may reduce mortality and mechanical ventilation duration in COVID-19 ARDS patients. This study supports the future performance of randomized clinical trials evaluating the efficacy of meticulous sub-bronchial lavage with surfactant as treatment for patients with COVID-19 ARDS.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Phospholipids / Biological Products / Pulmonary Surfactants / COVID-19 Drug Treatment / Lung Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Respir Res Year: 2021 Document Type: Article Affiliation country: S12931-020-01603-w

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Phospholipids / Biological Products / Pulmonary Surfactants / COVID-19 Drug Treatment / Lung Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: Respir Res Year: 2021 Document Type: Article Affiliation country: S12931-020-01603-w