Use of inhaled surfactant in the combination treatment of severe pneumonia: Clinical experience of the Krasnoyarsk Regional Clinical Hospital

Introduction. Severe pneumonia complicated by acute respiratory distress syndrome (ARDS) is associated with high mortality, necessitating the search for additional pathogenetic treatment methods. One of the key pathogenesis factors is secondary pulmonary surfactant deficiency. Despite compelling theoretical support, the clinical efficacy of inhaled exogenous surfactants in adult patients remains controversial.

Aim. To retrospectively analyze the efficacy and safety of inhaled surfactant in combination therapy for patients with severe pneumonia complicated by ARDS.

Materials and methods. This retrospective cohort study included 48 patients with severe pneumonia (community-acquired – 56.3%, influenza-associated – 27.1%, COVID-19 – 16.6%) who received inhaled surfactant-BL at a dose of 75 mg twice daily for 7 [5; 9] days in addition to standard therapy, including respiratory support and antimicrobial therapy. Efficacy was assessed based on changes in oxygen saturation (SpO₂).

Results. All patients initially experienced severe hypoxemia (median SpO₂ before therapy 86 [80; 92] %). Positive changes were observed during therapy: after 72 hours, the median SpO₂ increased to 92 [89; 96] %, and by the time of discharge, it reached 96 [89; 99] %. Overall survival in the cohort was 66.7% (32 patients). Mortality (33.3%, 16 patients) was recorded in the most severe subgroup with a fulminant course and severe comorbidity.

Conclusion. The addition of inhaled surfactant-BL to combination therapy for severe pneumonia with ARDS is associated with a significant improvement in oxygenation and acceptable survival rates in critically ill patients.

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