Perioperative lung expansion and pulmonary outcomes after open abdominal surgery versus usual care in the USA (PRIME-AIR): a multicentre, randomised, controlled, phase 3 trial.

Summary

In this multicentre phase 3 RCT of adults undergoing major open abdominal surgery at intermediate/high PPC risk, adherence to a perioperative lung expansion bundle was high (72–98%). The intervention increased intraoperative mean PEEP relative to usual care; 751 participants were analyzed in the mITT cohort.

Key Findings

• Multicentre phase 3 RCT enrolled 794 patients; mITT analysis included 751 (379 intervention, 372 usual care).
• Adherence to bundle components was high (72–98%).
• Intervention group received higher intraoperative mean PEEP (reported mean 7.5 cmH2O) than usual care.
• Eligibility targeted ARISCAT ≥26 and BMI <35 kg/m² for elective open abdominal surgeries ≥2 hours.

Clinical Implications

Supports structured, individualized intraoperative lung expansion strategies with demonstrable implementation fidelity. Pending full outcome details, programs can emulate high-adherence protocols and PEEP titration strategies in at-risk open abdominal surgeries.

Limitations

• Abstract does not report definitive PPC outcome effect sizes in the provided excerpt.
• Generalizability limited to BMI <35 kg/m² and open abdominal procedures ≥2 hours; blinding of intraoperative teams is inherently challenging.

Future Directions

Report detailed PPC severity and incidence outcomes, subgroup effects (e.g., ARISCAT strata), and implementation across diverse BMI and laparoscopic populations.