Simone Piva1,2, Robert M DiBlasi3,4, April E Slee5, Alan H Jobe6,7,8, Aldo M Roccaro9, Matteo Filippini10,11, Nicola Latronico10,11, Michele Bertoni10,11, John C Marshall12, Michael A Portman4,13. 1. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. simone.piva@unibs.it. 2. Department of Anaesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. simone.piva@unibs.it. 3. Respiratory Therapy Department, Seattle Children's Hospital, Seattle, WA, USA. 4. Center for Integrative Brain Research, Seattle Children's Research Institute, Seattle, WA, USA. 5. University College London, London, UK. 6. Perinatal Institute Cincinatti Children's Hospital, Cincinnati, OH, USA. 7. Children's Hospital of Cincinnati, Cincinnati, OH, USA. 8. University of Cincinatti, Cincinatti, OH, USA. 9. Clinical Research Development and Phase I Unit ASST Spedali Civili Di Brescia, Brescia, Italy. 10. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy. 11. Department of Anaesthesia, Critical Care and Emergency, Spedali Civili University Hospital, Piazzale Spedali Civili, 1, 25123, Brescia, Italy. 12. Li Ka Shing Knowledge Institute, Unity Health Toronto, University of Toronto, Toronto, ON, Canada. 13. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA.
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.
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-19ARDSpatients 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 ARDSpatients 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-19ARDSpatients and health care providers during the pandemic. Surfactant administration did not cause acute decompensation, may reduce mortality and mechanical ventilation duration in COVID-19ARDSpatients. 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-19ARDS.
Authors: Francesco Cattel; Susanna Giordano; Cecilia Bertiond; Tommaso Lupia; Silvia Corcione; Matilde Scaldaferri; Lorenzo Angelone; Francesco Giuseppe De Rosa Journal: Respir Physiol Neurobiol Date: 2021-02-28 Impact factor: 2.821
Authors: Laura Bergantini; Alessandro Mainardi; Miriana d'Alessandro; Paolo Cameli; David Bennett; Elena Bargagli; Piersante Sestini Journal: Front Pharmacol Date: 2022-03-04 Impact factor: 5.810