See the published version of this article at Respiratory Research.
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Surfactant Therapy for COVID-19 Related ARDS: A Retrospective Case-Control Pilot Study.
Simone Piva
University of Brescia: Universita degli Studi di Brescia
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5483-8007
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Respiratory Research.
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.
Keywords
Covid-19, Acute Respiratory Distress Syndrome, Surfactant Replacement Therapy
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CURRENT STATUS: Published
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Posted 22 Sep, 2020
Published
On 18 Jan, 2021
No community comments so far
Reviewer #2 agreed
On 07 Dec, 2020
Review #2 received
Received 07 Dec, 2020
Review #1 received
Received 26 Nov, 2020
Reviewer #1 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 23 Oct, 2020
Editor assigned
On 17 Sep, 2020
Submission checks complete
On 16 Sep, 2020
Editor invited
On 16 Sep, 2020
First submitted
On 15 Sep, 2020
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This preprint is under consideration at Respiratory Research. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Surfactant Therapy for COVID-19 Related ARDS: A Retrospective Case-Control Pilot Study.
Simone Piva
University of Brescia: Universita degli Studi di Brescia
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5483-8007
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 1
Posted 22 Sep, 2020
Published
On 18 Jan, 2021
No community comments so far
Reviewer #2 agreed
On 07 Dec, 2020
Review #2 received
Received 07 Dec, 2020
Review #1 received
Received 26 Nov, 2020
Reviewer #1 agreed
On 23 Nov, 2020
Reviewers invited
Invitations sent on 23 Oct, 2020
Editor assigned
On 17 Sep, 2020
Submission checks complete
On 16 Sep, 2020
Editor invited
On 16 Sep, 2020
First submitted
On 15 Sep, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Respiratory Research.
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.