Exogenous surfactant in the treatment of severe pneumonia caused by the SARS-CoV-2 virus

Background. Experimental and clinical evidence of the effectiveness of surfactant application in treatment of influenza A/H1N1 became prerequisites for the use of surfactant in the treatment of patients with COVID-19. Objective. To analyze the results of the application of a surfactant inhalation therapy in the SARS-CoV-2 severe pneumonia treatment. Design and methods. The present study represents retrospective controlled study, including 68 patients with severe viral pneumonia. Inclusion criteria: confirmed SARS-Cov-2 infection; bilateral polysegmental COVID-19 pneumonia with a lesion of at least 2 deg. according to CT data; SpO2 less than 92 % with face mask oxygen supplementation ≥ 6 l/min flow. Exclusion criteria: wrong in-closure administration of Surfactant-BL; invasive mechanical ventilation. Twenty-eight patients received traditional therapy (antiviral, anti-inflammatory, anticoagulant) combined with inhalation of Surfactant-BL at a dose of 1 mg/kg, 2–3 times a day, for 3–5 days. Forty patients from the control group received only traditional therapy. Results. In the group of patients who were treated in the infectious diseases department (16 patients received surfactant, 20 — traditional therapy), a significant increase in SaO2 after 24 h of therapy, a lower risk of transfer to the ICU (6.25 % when using surfactant, 45 % — in control cases, p = 0.011), a tendency towards lower mortality (6.25 % when using a surfactant, 30 % in control, p = 0.084) were found. In the group of patients treated in the ICU and receiving non-invasive respiratory support (non-invasive mask mechanical ventilation or high-flow oxygen therapy, 12 patients received surfactant, 20 — traditional therapy), a significant increase in SaO2 was found after 24 h of therapy, a significantly lower risk of transfer to invasive mechanical ventilation (25 % with surfactant therapy and 75 % — in control group, p = 0.008) and significantly lower mortality (25 % with surfactant therapy and 75 % in control cases, p = 0.008). In the combined group of inhalation surfactant therapy, 4 out of 28 patients (14.3 %) died, in the control group 21 out of 40 patients (52.5 %) died, p = 0.001. Conclusion. The inclusion of surfactant therapy in the treatment of severe SARS-CoV-2 pneumonia made it possible to improve oxygenation, significantly reduce the need in invasive mechanical ventilation, and reduce mortality. Considering the limitations of the study, this technique effectiveness confirmation requires multicenter randomized controlled trials.

acute respiratory distress syndrome, acute respiratory failure, COVID-19, surfactant, viral pneumonia

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