At a glance
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An Anesthesia-Centered Bundle to Reduce Postoperative Pulmonary Complications: The PRIME-AIR Study
In Brief
A clinical study evaluating Preoperative Education, Intraoperative PEEP (Positive End-Expiratory Pressure) Individualization, and 3 other interventions for Postoperative Pulmonary Complications. Completed, enrolled 794 participants across 16 sites.
Detailed Summary
Postoperative pulmonary complications (PPCs) are a major cause of morbidity and mortality in surgical patients. National estimates suggest 1,062,000 PPCs per year, with 46,200 deaths, and 4.8 million additional days of hospitalization. The objective of the study is to develop and implement perioperative strategies to eliminate PPCs in abdominal surgery, the field with the largest absolute number of PPCs. We will conduct a randomized controlled pragmatic trial in 750 studied participants. The effectiveness of an individualized perioperative anesthesia-centered bundle will be compared to the usual anesthetic care in patients receiving open abdominal surgery. At the end of this project, the investigators expect to change clinical practice by establishing a new and clinically feasible anesthesia-centered strategy to reduce perioperative lung morbidity. The research will be conducted across 14 US academic centers, and will be funded by the National Institute of Health.
Study Details
Timeline
Interventions
Brochure and video about relevance of postoperative pulmonary complications, postoperative mobilization and use of incentive spirometry.
PEEP will be set by maximizing respiratory system compliance along a decremental PEEP titration following an incremental recruitment maneuver.
Administration of neuromuscular blocking agents and their reversal will be done based on established protocol.
Participants will be encouraged to adhere to incentive spirometry to be started 2 hours after surgery and maintained until participant freely ambulates. Supervision will be provided 3 times/day for continuous education and management of barriers to optimal performance.
Participants will be encouraged to adhere to prescription of early ambulation.