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Rationale: Management of first episodes of primary spontaneous pneumothorax remains the subject of debate. Objectives: To determine whether first-line simple aspiration is noninferior to first-line chest tube drainage for lung expansion in patients with complete primary spontaneous pneumothorax. Methods: We conducted a prospective, open-label, randomized noninferiority trial. Adults aged 18–50 years with complete primary spontaneous pneumothorax (total separation of the lung from the chest wall), recruited at 31 French hospitals from 2009 to 2015, received simple aspiration (n = 200) or chest tube drainage (n = 202) as first-line treatment. The primary outcome was pulmonary expansion 24 hours after the procedure. Secondary outcomes were tolerance of treatment, occurrence of adverse events, and recurrence of pneumothorax within 1 year. Substantial discordance in the numerical inputs used for trial planning and the actual trial rates of the primary outcome resulted in a reevaluation of the trial analysis plan. Measurement and Main Results: Treatment failure occurred in 29% in the aspiration group and 18% in the chest tube drainage group (difference in failure rate, 0.113; 95% confidence interval [CI], 0.026–0.200). The aspiration group experienced less pain overall (mean difference, −1.4; 95% CI, −1.89, −0.91), less pain limiting breathing (frequency difference, −0.18; 95% CI, −0.27, −0.09), and less kinking of the device (frequency difference, −0.05; 95% CI, −0.09, −0.01). Recurrence of pneumothorax was 20% in this group versus 27% in the drainage group (frequency difference, −0.07; 95% CI, −0.16, +0.02). Conclusions: First-line management of complete primary spontaneous pneumothorax with simple aspiration had a higher failure rate than chest tube drainage but was better tolerated with fewer adverse events. [ABSTRACT FROM AUTHOR]

The article focuses on the importance of randomized controlled studies in informing clinical practice guidelines. Topics include the design and findings of the EXPRED study comparing simple aspiration and standard thoracic drainage for pneumothorax treatment, challenges in applying recommendations at the patient's bedside, and the development of French recommendations for spontaneous pneumothorax management.

Background: The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use., Objective: To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED., Methods: We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4)., Results: The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024., Conclusions: While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use., Trial Registration: PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598., International Registered Report Identifier (irrid): DERR1-10.2196/50682., (©Simon Berthelot, Yves Longtin, Manuele Margni, Jason Robert Guertin, Annie LeBlanc, Tania Marx, Khadidiatou Mangou, Ariane Bluteau, Diego Mantovani, Sergey Mikhaylin, Frédéric Bergeron, Valérie Dancause, Anne Desjardins, Nadia Lahrichi, Danielle Martin, Charles Jérôme Sossa, Philippe Lachapelle, Isabelle Genest, Stéphane Schaal, Anne Gignac, Stéphane Tremblay, Éric Hufty, Lynda Bélanger, Erica Beatty. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 07.12.2023.)