Conclusions
This phase 2 randomised controlled trial of natural nebulized surfactant using novel breath-synchronised delivery combined with a photo defined aperture plate (PDAP) vibrating mesh nebulizer in mechanically ventilated patients with severe COVID-19 is feasible and safe. However, the trial did not demonstrate improvement in oxygenation after 48 h of randomisation and does not support routine use of surfactant in severe COVID-19.