A Clinical Trial of Nebulized Surfactant for the Treatment of Moderate to Severe COVID-19
- Conditions
- Respiratory Infections
- Interventions
- Device: COVSurf Drug Delivery SystemOther: Standard of Care
- Registration Number
- NCT04362059
- Brief Summary
Lung surfactant is present in the lungs. It covers the alveolar surface where it reduces the work of breathing and prevents the lungs from collapsing. In some respiratory diseases and in patients that require ventilation this substance does not function normally. This study will introduce surfactant to the patients lungs via the COVSurf Drug Delivery System
- Detailed Description
The hypothesis behind the proposed trial of surfactant therapy for COVID-19 infected patients requiring ventilator support is that endogenous surfactant is dysfunctional. This could be due to decreased concentration of surfactant phospholipid and protein, altered surfactant phospholipid composition, surfactant protein proteolysis and/or oedema protein inhibition of surfactant surface tension function and/or oxidative inactivation of surfactant proteins. Variations of these dysfunctional mechanisms have been reported in a range of lung diseases, including cystic fibrosis and severe asthma, and in child and adult patients with ARDS. Our studies of surfactant metabolism in adult ARDS patients showed altered percentage composition of surfactant PC, with decreased DPPC and increased surface tension-inactive unsaturated species, and decreased concentrations of both total PC and phosphatidylglycerol (PG)
The SARS-CoV-2 virus binds to the angiotensin converting enzyme-2 (ACE2) receptor, which is preferentially expressed in the peripheral lung ATII cells. Consequent viral infection of ATII cells could reduce cell number and impair the capacity of the lungs to synthesise and secrete surfactant. This, however, has not yet been demonstrated empirically in COVID-19 patients. If this is the case, then exogenous surfactant administration to the lungs is potential one treatment option to mitigate disease severity in these patients.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 20
- Age ≥18 years old
- Confirmed COVID-19 positive by PCR
- Within 24 hours of mechanical ventilation (ETI arm) or within 24 hours of needing either CPAP or NIV (CPAP/NIV arm)
- Assent or professional assent obtained
- Imminent expected death within 24 hours
- Specific contraindications to surfactant administration (e.g. known allergy, pneumothorax, pulmonary haemorrhage)
- Known or suspected pregnancy
- Stage 4 severe chronic kidney disease or requiring dialysis (i.e., eGFR < 30)
- Liver failure
- Anticipated transfer to another hospital, which is not a study site within 72 hours.
- Current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes.
- Consent Declined
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Treatment Arm COVSurf Drug Delivery System Patients will be administered surfactant via COVSurf Drug Delivery System Control Arm Standard of Care Patients shall receive regular Standard of Care treatment
- Primary Outcome Measures
Name Time Method Oxygenation Improvement 3 months To assess the improvement in oxygenation as determined by the PaO2/FiO2 ratio after treatment with study treatment
Pulmonary ventilation Improvement 3 months To assess the improvement in pulmonary ventilation as determined by the Ventilation Index (VI), where VI = (Respiratory rate X PIP X PaCo2 (mmHg)/ 1000 after study treatment.
IMV Need 3 months Need for invasive mechanical ventilation (IMV) (CPAP/NIV arm only)
- Secondary Outcome Measures
Name Time Method Duration of days 3 months Duration of days of IMV or NIV or CPAP
Number of days hospitalised 3 months Number of days hospitalised
Mean Change in pulmonary compliance 48 hours Mean change in pulmonary compliance (L/cmH2O) at 24 and 48 hours after study initiation in the IMV arm
Safety Assessment of Frequency and Severity of Adverse Events 3 months To assess safety as judged by the frequency and severity of adverse events and severe adverse events (SAEs).
Mean Change in PEEP requirement 48 Hours Mean change in PEEP (Positive End-Expiratory Pressure) requirement at 24 and 48 hours after study initiation
Clinical Improvement 28 days To evaluate clinical improvement defined by time to one improvement point on an ordinal scale, as described in the WHO master protocol (2020) daily while hospitalised and on days 15 and 28
Change in PaO2/FiO2 ratio 3 months Mean change in PaO2/FiO2 ratio at 24 and 48 hours after study initiation.
Mean Change in ventilatory index 48 hours Mean change in ventilatory index (VI) at 24 and 48 hours after study initiation
Mechanical ventilation duration 3 months Duration of mechanical ventilation
Length of ICU stay 3 months Length of intensive care unit stay
IMV free days 21 days Invasive Mechanical Ventilator (IMV) free days at day 21
Ventilator support free days 21 days Ventilator support (IMV or NIV or CPAP) free days (VSFD) at day 21
Mortality 28 days Mortality at day 28
Trial Locations
- Locations (2)
University College London Hospitals NHS Foundation Trust
🇬🇧London, United Kingdom
University Hospital Southampton NHS Foundation Trust
🇬🇧Southampton, Hampshire, United Kingdom