An anesthesia-centered bundle to reduce postoperative pulmonary complications: The PRIME-AIR study protocol

Area of Science:

• Anesthesiology
• Critical Care Medicine
• Thoracic Surgery

Background:

• Postoperative pulmonary complications (PPCs) significantly increase morbidity and mortality following open abdominal surgery.
• Optimized perioperative lung expansion strategies are crucial for mitigating the multifactorial causes of pulmonary dysfunction.
• This research addresses the need for effective interventions to prevent PPCs in high-risk surgical patients.

Purpose of the Study:

• To evaluate an anesthesia-centered bundle of care focused on perioperative lung expansion.
• To determine if this intervention reduces the incidence and severity of PPCs after open abdominal surgery.
• To assess the impact on healthcare utilization and patient-reported outcomes.

Main Methods:

• A prospective, multicenter, randomized controlled pragmatic trial involving 750 adult patients undergoing prolonged open abdominal surgery.
• Participants are randomized to receive either a lung expansion bundle or usual care.
• The bundle includes preoperative education, protective ventilation, optimized neuromuscular blockade, and postoperative respiratory support and mobilization.

Main Results:

• Primary outcome: distribution of highest PPC severity by postoperative day 7.
• Secondary outcomes: PPC grades, intraoperative events (hypoxemia, cardiovascular events), extrapulmonary complications, length of respiratory support, hospital resource use.
• Exploratory outcomes: Patient-Reported Outcomes Measurement Information System (PROMIS) for dyspnea/fatigue, lung injury biomarkers.

Conclusions:

• The study aims to determine if an anesthesia-centered perioperative lung expansion strategy can decrease lung morbidity and healthcare utilization.
• Results are anticipated in 2024, providing evidence for optimizing patient recovery after major abdominal surgery.
• This trial will inform clinical practice regarding the prevention of PPCs in at-risk surgical populations.