Effects of lung recruitment maneuver using mechanical ventilator in preterm infant microcirculation: a clinical trial

Adhi Teguh Perma Iskandar; Mulyadi Muhammad Djer; Bambang Supriyatno; Risma Kerina Kaban; Ahmad Kautsar; Anisa Rahmadhany; Fiolita Indranita Sutjipto; Suhendro; Najib Advani; Dewi Irawati Soeria Santoso; Joedo Prihartono; Tetty Yuniati

doi:10.13181/mji.oa.247472

Authors

Adhi Teguh Perma Iskandar Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Mulyadi Muhammad Djer Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Bambang Supriyatno Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Risma Kerina Kaban Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Ahmad Kautsar Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Anisa Rahmadhany Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Fiolita Indranita Sutjipto Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Suhendro Department of Internal Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Najib Advani Department of Child Health, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Dewi Irawati Soeria Santoso Department of Physiology, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Joedo Prihartono Department of Community Medicine, Faculty of Medicine, Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
Tetty Yuniati Department of Child Health, Faculty of Medicine, Universitas Padjadjaran, Hasan Sadikin Hospital, Bandung, Indonesia

DOI:

https://doi.org/10.13181/mji.oa.247472

Keywords:

bronchopulmonary dysplasia, endothelial cell, mechanical ventilation, platelet endothelial cell adhesion molecule-1, pulmonary surfactant-associated protein D

Abstract

BACKGROUND Preterm infants often require continuous positive airway pressure due to immature respiratory tracts. Bronchopulmonary dysplasia (BPD) manifests as prolonged oxygen dependence until 28 days of age and is classified into mild, moderate, or severe forms. The lung recruitment maneuver (LRM) aims to reopen collapsed alveoli, enhancing oxygenation during mechanical ventilation using the assist control volume guarantee mode (MV-AC/VG). This study aimed to evaluate the impact of LRM on alveolar and endothelial injuries, neonatal microcirculation, and its relation to BPD reduction or mortality in preterm infants.

METHODS This study was conducted from March 2021 to April 2022 at Cipto Mangunkusumo and Bunda Menteng Hospitals, Jakarta. The participants are <32 weeks infants with severe respiratory distress syndrome requiring MV-AC/VG, divided into LRM and control groups (n = 55 each). The alveolar injury was assessed using plasma surfactant protein-D (SP-D), endothelial injury by flow cytometry for endothelial microparticles (CD-31⁺/CD-42^-), and neonatal microcirculation via transcutaneous-artery CO₂ gap (TcPCO₂-PaCO₂) and transcutaneous O₂ index (TcPO₂/PaO₂) measurements at 1 and 72 hours post-ventilation.

RESULTS LRM did not negatively affect preterm infants (24–32 weeks) undergoing invasive mechanical ventilation. At 72 hours, no significant differences were observed in alveolar (SP-D) and endothelial injury (CD-31⁺/CD-42^-), nor in BPD reduction or mortality by 36 weeks.

CONCLUSIONS LRM is a beneficial intervention for enhancing respiratory support and microcirculation in preterm infants. Among survivors, LRM reduced the time to achieve the lowest FiO₂ (60.0 versus 435.0 hours, p<0.0001), shortened respiratory support duration (25.0 versus 36.83 days, p = 0.044), and improved TcO₂ index (1.00 versus 1.00, p = 0.009).

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