# 1/2: An Anesthesia-Centered Bundle to Reduce Postoperative Pulmonary Complications: The PRIME-AIR Study

> **NIH NIH UH3** · MASSACHUSETTS GENERAL HOSPITAL · 2020 · $2,084,948

## Abstract

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. Abdominal surgery is the field with the largest absolute number of PPCs. Our long-term
goal is to develop and implement perioperative strategies to eliminate PPCs. Whereas PPCs are as significant
and lethal as cardiac complications, research in the field has received much less attention, and strategies to
minimize PPCs are regrettably limited. Recently, we and others have suggested a crucial role of anesthesia
related interventions such as ventilatory strategies, and administration and reversal of neuromuscular blocking
agents in reducing PPCs. These findings are consistent with the beneficial effects of lung protective ventilation
during the adult respiratory distress syndrome (ARDS). While surgical patients differ substantially from ARDS
patients as most have no or limited lung injury at the start of surgery, intraoperative anesthetic and abdominal
surgery interventions result in lung derecruitment and predispose to or produce direct and indirect, potentially
multiple-hit, lung injury. Thus, effective anesthetic strategies aiming at early lung protection in this group of
patients are greatly needed. Indeed, the current lack of evidence results in wide and unexplained variability in
anesthetic practices creating a major public health issue as some practices within usual care appear to be
suboptimal and even potentially injurious. We hypothesize that an anesthesia-centered bundle, based on our
recent findings and focused on perioperative lung protection, will minimize multiple and synergistic factors
responsible for the multiple-hit perioperative pulmonary dysfunction and result in decreased incidence and
severity of PPCs. Founded on strong preliminary data, we will leverage a network of US academic centers to
study this hypothesis in two aims: Aim 1. To compare the number and severity of PPCs in patients receiving
an individualized perioperative anesthesia-centered bundle to those in patients receiving usual anesthetic care
during open abdominal surgery. For this, we propose to conduct a prospective multicenter randomized
controlled pragmatic trial with a blinded assessor in a total of 750 patients. The bundle will consist of optimal
mechanical ventilation comprising individualized positive end-expiratory pressure to maximize respiratory
system compliance and minimize driving pressures, individualized use of neuromuscular blocking agents and
their reversal, and postoperative lung expansion and early mobilization; Aim 2. To assess the effect of the
proposed bundle on plasma levels of lung injury biomarkers. We theorize that our intervention will minimize
overinflation and atelectasis reducing plasma levels of biomarkers of lung inflammatory, epithelial, and
endothelial injury. Such mechanistic insights will facilit...

## Key facts

- **NIH application ID:** 9896976
- **Project number:** 4UH3HL140177-02
- **Recipient organization:** MASSACHUSETTS GENERAL HOSPITAL
- **Principal Investigator:** Ana Fernandez-Bustamante
- **Activity code:** UH3 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $2,084,948
- **Award type:** 4N
- **Project period:** 2019-03-19 → 2024-02-29

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9896976

## Citation

> US National Institutes of Health, RePORTER application 9896976, 1/2: An Anesthesia-Centered Bundle to Reduce Postoperative Pulmonary Complications: The PRIME-AIR Study (4UH3HL140177-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9896976. Licensed CC0.

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