Inhaled surfactant looks good for COVID-19-related ARDS

Inhaled surfactant therapy shows promise in the treatment of patients with acute respiratory distress syndrome (ARDS) associated with COVID-19, as shown in a study.

Pulmonary surfactant works to reduce surface tension in alveoli in order to prevent lung collapse and gas exchange. Moreover, the surfactant affects innate and adaptive local immunity by being involved in the barrier and protective function of the lungs. Demonstrating anti-inflammatory properties, the surfactant lowers the expression of tumour necrosis factor-alpha, interleukin (IL)-1, IL-6, and, therefore, may efficiently contribute to the repair of damaged alveoli in SARS-CoV-2-associated ARDS.

The current study included 33 patients who were given inhaled surfactant at 150–300 mg daily for at least 5 days and control patients who did not receive the treatment. All of them received standard therapy, including hydroxychloroquine (400 mg daily), azithromycin (500 mg daily), dexamethasone (6–12 mg daily), prophylactic enoxaparin (40 mg daily), and tocilizumab (8 mg/kg).

At day 5 of therapy, arterial oxygen tension to inspired oxygen fraction ratio (PaO₂/FiO₂) showed a meaningful improvement in the surfactant group than in the control group (184 vs 150 mm Hg; p=0.02). Patients who received the inhaled surfactant were less likely to be transferred to intensive care units (24.2 percent vs 46.9 percent; p=0.05) and be put on invasive mechanical ventilation (18.2 percent vs 40.6 percent; p=0.04).

Moreover, treatment with the exogenous surfactant led to a shorter length of noninvasive ventilation (7 vs 11 days; p=0.02) and duration of hospital stay (18 vs 26 days; p=0.003).

The present data warrant larger trials of inhaled surfactant therapy for COVID-19-associated ARDS.