Inclusion Criteria:  age over 18 years definitive proof of COVID-19 infection by polymerase chain reaction (PCR) within 48 hours of hospital admission COVID-19 related Moderate ARDS following Berlin criteria definition with PaO2/FiO2 < 200 requiring what condition? Signed and dated informed consent form (ICF) by the subject or caregivers  Exclusion Criteria:  known or high suspicion of pre-existing heart failure, unstable angina presence of severe shock with hemodynamic instability despite escalating vasopressors Severe, underlying pulmonary infection or severe pulmonary disease except for COVID-19 (COPD, pulmonary fibrosis, lung cancer, bacterial pneumonia, etc.) Diagnosis of pulmonary hemorrhage Pregnancy or lactation Other significant cause than ARDS to the respiratory failure Age less than 18 Age more than 80 Need for ECMO (extracorporeal membrane oxygenation) during the study Anticipated transfer to another hospital within 72 hours Known hypersensitivity to exogenous surfactant Current participation or participation in another study within the last month that in the opinion of the investigator would prevent enrollment for safety purposes