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Schluep M, Minheere M, Baus M, Machielse S, Donkers A, Vroman H. Reducing plastic waste in intensive care from longer use of intravenous administration and invasive monitoring sets: A before-and-after study. J Crit Care 2024; 84:154900. [PMID: 39182456 DOI: 10.1016/j.jcrc.2024.154900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 08/13/2024] [Accepted: 08/16/2024] [Indexed: 08/27/2024]
Abstract
INTRODUCTION Intensive care unit (ICU) treatment carries a large environmental burden. Extending routine replacement of plastic line sets that belong to intravenous administration or invasive monitoring might lower waste from single-use plastics in ICUs. We extended the routine replacement interval of line sets from 4 to 7 days and assessed plastic waste reduction. METHODS In this single center retrospective study the extension of the time interval from 4 to 7 days for routine replacement of line sets and its effect on plastic waste was assessed. The intervention was done at the start of 2022. Secondary outcomes were catheter-related bloodstream infections (CRBSI), nursing workload, costs and material durability. RESULTS In total 1221 patients were admitted to ICU; 636 in the pre-intervention period and 585 in the post-intervention period. There was a reduction of 881 replacement sets, 182 kg of waste and 96 nursing hours in 2022. There was no difference in CRBSI incidence. CONCLUSION This study demonstrates the benefits of 7-day replacement intervals for intravenous administration and invasive monitoring sets. We established this in terms of waste reduction, patient safety and costs.
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Affiliation(s)
- Marc Schluep
- Department of Intensive Care Medicine, Bravis Hospital, Bergen op Zoom, the Netherlands.
| | - Martijn Minheere
- Department of Intensive Care Medicine, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Michelle Baus
- Department of Intensive Care Medicine, Bravis Hospital, Bergen op Zoom, the Netherlands; Department of Intensive Care, Erasmus MC, Rotterdam, the Netherlands
| | - Stefan Machielse
- Department of Infection Prevention and Control, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Anita Donkers
- Department of Sustainability, Bravis Hospital, Bergen op Zoom, the Netherlands
| | - Heleen Vroman
- Department of Science, Bravis Hospital, Bergen op Zoom, the Netherlands
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2
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Chen RX. Green ICU is good, but not perfect. Intensive Care Med 2024; 50:1508. [PMID: 39017698 DOI: 10.1007/s00134-024-07555-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/08/2024] [Indexed: 07/18/2024]
Affiliation(s)
- Ren-Xiong Chen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), ICU, Peking University Cancer Hospital & Institute, No. 52 of Fucheng Road, Haidian District, Beijing, 100142, China.
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3
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Teiten C, Bailly P, Tonnelier JM, Bodenes L, de Longeaux K, L'Her E. Impact of inhaled sedation on delirium incidence and neurological outcome after cardiac arrest - A propensity-matched control study (Isocare). Resuscitation 2024:110358. [PMID: 39147307 DOI: 10.1016/j.resuscitation.2024.110358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 08/17/2024]
Abstract
RATIONALE Poor neurological outcome is common following a cardiac arrest. The use of volatile anesthetic agents has been proposed during post-resuscitation to improve outcome. OBJECTIVES To determine the effects of inhaled isoflurane on neurological outcome, delirium incidence, ICU length-of-stay, ventilation duration, mortality during post-resuscitation care of ICU patients. PATIENTS 510 patients were admitted within our medical ICU following a cardiac arrest during the study period, 401 of them being sedated using intravenous sedation prior to 2017 and 109 of them using inhaled isoflurane according to a standardized protocol following 2017. RESULTS Matched-pair analysis depicted a delirium incidence decrease, without improved neurologic outcome on ICU discharge (CPC ≤ 2) for isoflurane patients (16.1% vs 32.2%, p 0.03 and 29% vs 23%, p 0.47, respectively). Ventilation duration and ICU length of stay were shorter for isoflurane patients (78 vs 167 h, p 0.01 and 7.9 vs 8.5 days, p 0.01 respectively). Isoflurane had no impact on mortality. CONCLUSION In this propensity-matched control study, isoflurane sedation during the post-resuscitation care of ICU patients was associated with a lower incidence of delirium, a shorter duration of mechanical ventilation and a reduced ICU length of stay. Prospective data are needed before its widespread use.
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Affiliation(s)
- Christelle Teiten
- Médecine Intensive Réanimation, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France
| | - Pierre Bailly
- Médecine Intensive Réanimation, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France.
| | - Jean-Marie Tonnelier
- Médecine Intensive Réanimation, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France
| | - Laetitia Bodenes
- Médecine Intensive Réanimation, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France
| | - Kahaia de Longeaux
- Médecine Intensive Réanimation, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France
| | - Erwan L'Her
- Médecine Intensive Réanimation, CHU de la Cavale Blanche, Bvd Tanguy-Prigent, 29609 Brest Cedex, France; Laboratoire de Traitement de l'Information Médicale INSERM Mixte de Recherche Unité 1101, Université de Bretagne Occidentale, France
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4
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Nguyen CD, Panganiban HP, Fazio T, Karahalios A, Ankravs MJ, MacIsaac CM, Rechnitzer T, Arno L, Tran-Duy A, McAlister S, Ali Abdelhamid Y, Deane AM. A Randomized Noninferiority Trial to Compare Enteral to Parenteral Phosphate Replacement on Biochemistry, Waste, and Environmental Impact and Healthcare Cost in Critically Ill Patients With Mild to Moderate Hypophosphatemia. Crit Care Med 2024; 52:1054-1064. [PMID: 38537225 DOI: 10.1097/ccm.0000000000006255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Hypophosphatemia occurs frequently. Enteral, rather than IV, phosphate replacement may reduce fluid replacement, cost, and waste. DESIGN Prospective, randomized, parallel group, noninferiority clinical trial. SETTING Single center, 42-bed state trauma, medical and surgical ICUs, from April 20, 2022, to July 1, 2022. PATIENTS Patients with serum phosphate concentration between 0.3 and 0.75 mmol/L. INTERVENTIONS We randomized patients to either enteral or IV phosphate replacement using electronic medical record-embedded program. MEASUREMENT AND MAIN RESULTS Our primary outcome was serum phosphate at 24 hours with a noninferiority margin of 0.2 mmol/L. Secondary outcomes included cost savings and environmental waste reduction and additional IV fluid administered. The modified intention-to-treat cohort comprised 131 patients. Baseline phosphate concentrations were similar between the two groups. At 24 hours, mean ( sd ) serum phosphate concentration were enteral 0.89 mmol/L (0.24 mmol/L) and IV 0.82 mmol/L (0.28 mmol/L). This difference was noninferior at the margin of 0.2 mmol/L (difference, 0.07 mmol/L; 95% CI, -0.02 to 0.17 mmol/L). When assigned IV replacement, patients received 408 mL (372 mL) of solvent IV fluid. Compared with IV replacement, the mean cost per patient was ten-fold less with enteral replacement ($3.7 [$4.0] vs. IV: $37.7 [$31.4]; difference = $34.0 [95% CI, $26.3-$41.7]) and weight of waste was less (7.7 g [8.3 g] vs. 217 g [169 g]; difference = 209 g [95% CI, 168-250 g]). C O2 emissions were 60-fold less for comparable phosphate replacement (enteral: 2 g producing 14.2 g and 20 mmol of potassium dihydrogen phosphate producing 843 g of C O2 equivalents). CONCLUSIONS Enteral phosphate replacement in ICU is noninferior to IV replacement at a margin of 0.2 mmol/L but leads to a substantial reduction in cost and waste.
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Affiliation(s)
- Chinh D Nguyen
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | | | - Timothy Fazio
- Department of Medicine, Royal Melbourne Hospital, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Health Intelligence Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Amalia Karahalios
- Center for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Melissa J Ankravs
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Christopher M MacIsaac
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Thomas Rechnitzer
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Lucy Arno
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
- Pharmacy Department, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - An Tran-Duy
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Scott McAlister
- Melbourne Centre for Health Policy, University of Melbourne, Melbourne, VIC, Australia
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Yasmine Ali Abdelhamid
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Adam M Deane
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, VIC, Australia
- Intensive Care Unit, Royal Melbourne Hospital, Melbourne, VIC, Australia
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5
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Bell KJL, Stancliffe R. Less is more for greener intensive care. Intensive Care Med 2024; 50:746-748. [PMID: 38587554 DOI: 10.1007/s00134-024-07378-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024]
Affiliation(s)
- Katy J L Bell
- Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia.
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6
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Gabiña IS, José Pita López M. GREEN ICU: responsible and sustainable ICU. Med Intensiva 2024; 48:231-234. [PMID: 38519373 DOI: 10.1016/j.medine.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 10/28/2023] [Indexed: 03/24/2024]
Affiliation(s)
- Irene Salinas Gabiña
- Servicio de Medicina Intensiva, Hospital Universitario del Henares, Coslada, Madrid, Spain; Fisiología Facultad de Medicina, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
| | - M José Pita López
- Servicio de Medicina Preventiva, Hospital Universitario del Henares, Coslada, Madrid, Spain
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7
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Lehut T, Lambert C, Mortier R, Futier E, Chabanne R, Bauer U, Verdier P, Ravan R, Ocquidant P, Mourgues C, Lautrette A. Cost awareness among intensivists in their daily clinical practice: a prospective multicentre study. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2024:10.1007/s10198-024-01686-y. [PMID: 38472725 DOI: 10.1007/s10198-024-01686-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 02/13/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND Better cost-awareness is a prerogative in achieving the best benefit/risk/cost ratio in the care. We aimed to assess the cost-awareness of intensivists in their daily clinical practice and to identify factors associated with accurate estimate of cost (50-150% of the real cost). METHODS We performed a prospective observational study in seven French ICUs. We compared the estimate of intensivists of the daily costs of caring with the real costs on a given day. The estimates covered five categories (drugs, laboratory tests, imaging modalities, medical devices, and waste) whose sum represented the overall cost. RESULTS Of the 234 estimates made by 65 intensivists, 70 (29.9%) were accurate. The median overall cost estimate (€330 [170; 620]) was significantly higher than the real cost (€178 [124; 239], p < 0.001). This overestimation was found in four categories, in particular for waste (€40 [15; 100] vs. €1.1 [0.6; 2.3], p < 0.001). Only the laboratory tests were underestimated (€65 [30; 120] vs. €106 [79; 138], p < 0.001). Being aware of the financial impact of prescriptions was factor associated with accurate estimate (OR: 5.05, 95%CI:1.47-17.4, p = 0.01). However, feeling able to accurately perform estimation was factor negatively associated with accurate estimate (OR: 0.11, 95%CI: 0.02-0.71, p = 0.02). CONCLUSION French intensivists have a poor awareness of costs in their daily clinical practice. Raising awareness of the financial impact of prescriptions, and of the cost of laboratory tests and waste are the main areas for improvement that could help achieve the objective of the best care at the best cost.
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Affiliation(s)
- Timothée Lehut
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Céline Lambert
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Romain Mortier
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Futier
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Russell Chabanne
- Department of Anaesthesiology and Critical Care Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Ulrich Bauer
- Intensive Care Unit, Cancer Center Jean Perrin, Clermont-Ferrand, France
| | - Philippe Verdier
- Intensive Care Unit, Centre Hospitalier de Montluçon, Montluçon, France
| | - Ramin Ravan
- Intensive Care Unit, Centre Hospitalier Jacques Lacarin, Vichy, France
| | | | - Charline Mourgues
- Biostatistics Unit, DRCI, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Alexandre Lautrette
- Intensive Care Unit, Cancer Center Jean Perrin, Clermont-Ferrand, France.
- Intensive Care Medicine, CHU Clermont-Ferrand,Intensive Care Unit, Cancer Centre Jean Perrin, Clermont-Ferrand, 54 rue Montalembert BP69, Cedex 1, 63003, France.
- LMGE (Laboratoire Micro-organismes: Génome et Environnement), UMR CNRS 6023, Université Clermont Auvergne, Clermont-Ferrand, France.
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8
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Garcia Borrega J, Hermes C, König V, Kitz V, Möller S, Stark D, Janssens U, Mager D, Kochanek M. [Sustainability in intensive and emergency care : A nationwide survey by the German Society of Medical Intensive Care and Emergency Medicine]. Med Klin Intensivmed Notfmed 2024; 119:108-115. [PMID: 37341751 PMCID: PMC10901941 DOI: 10.1007/s00063-023-01039-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 05/31/2023] [Accepted: 06/06/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND The impact of climate change on humans is well known. However, the health care system is also a relevant contributor, accounting for up to 5-7% of global greenhouse gas emissions, and work should be adapted to be more sustainable. AIM The survey investigated whether sustainability plays a role in hospitals and specifically in the field of emergency and intensive care. Concrete measures and which hurdles are already recognized were also inquired. MATERIALS AND METHODS The "AG Nachhaltigkeit" (working group on sustainability) of the "Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin" (DGIIN) conducted an electronic survey among the staff of intensive care units, emergency rooms, and ambulance services in Germany. RESULTS In all, 218 survey results were included in the analysis: 108 (50%) participants were from the nursing sector and 98 (45%) belonged to the medical staff. The majority of participants work in an intensive care unit (181 [83%]) followed by intermediate care unit (52 [24%]). A total of 104 (47%) participants indicated that their workplace had already implemented sustainability measures. However, when asked whether decision-makers in the workplaces incorporate sustainability into their decisions, management scored highest with only 20%. Potential for improvement is seen in energy and waste management, among others. CONCLUSION The survey results show that (1) employees are highly motivated to address the issue of sustainability and to implement measures, (2) the potential to establish a resource-saving and environmentally friendly hospital is far from being exhausted, and (3) it must become a priority that decision-makers in the hospital propagate sustainability, make processes transparent, and support the motivation of employees on the subject of sustainability. In addition, this process must be supported by politicians and health insurance companies.
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Affiliation(s)
- Jorge Garcia Borrega
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Carsten Hermes
- Hochschule für angewandte Wissenschaften (HAW), Hamburg, Deutschland
- Akkon Hochschule für Humanwissenschaften, Berlin, Deutschland
| | | | - Valery Kitz
- Interdisziplinäre Intensivstation, Pflegeentwicklung, Agaplesion Diakonieklinikum Hamburg, Hohe Weide 17, 20259, Hamburg, Deutschland
| | - Sverrir Möller
- Interdisziplinäre konservative Intensivstation, Universitätsklinikum Schleswig-Holstein (UKSH), Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland
| | - Dominik Stark
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland
| | - Uwe Janssens
- Innere Medizin und Internistische Intensivmedizin, St-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - David Mager
- Krankenhaus der Barmherzigen Brüder Trier, Trier, Deutschland
| | - Matthias Kochanek
- Klinik I für Innere Medizin, Zentrum für Integrierte Onkologie Aachen Bonn Köln Düsseldorf, Uniklinik Köln, Kerpener Str. 62, 50937, Köln, Deutschland.
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9
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Branson RD, Ring BJ. Sustainability in Respiratory Therapy: Revisiting Reusables. Respir Care 2024; 69:275-279. [PMID: 38267233 PMCID: PMC10898465 DOI: 10.4187/respcare.11857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Affiliation(s)
- Richard D Branson
- Division of Acute Care Surgery, Trauma and Critical Care University of Cincinnati College of Medicine Cincinnati, Ohio
| | - Brian J Ring
- Division of Acute Care Surgery, Trauma and Critical Care University of Cincinnati College of Medicine Cincinnati, Ohio
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10
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Carrandi A, Nguyen C, Tse WC, Taylor C, McGain F, Thompson K, Hensher M, McAlister S, Higgins AM. How environmental impact is considered in economic evaluations of critical care: a scoping review. Intensive Care Med 2024; 50:36-45. [PMID: 38191675 PMCID: PMC10810918 DOI: 10.1007/s00134-023-07274-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/11/2023] [Indexed: 01/10/2024]
Abstract
PURPOSE Health care is a major contributor to climate change, and critical care is one of the sector's highest carbon emitters. Health economic evaluations form an important component of critical care and may be useful in identifying economically efficient and environmentally sustainable strategies. The purpose of this scoping review was to synthesise available literature on whether and how environmental impact is considered in health economic evaluations of critical care. METHODS A robust scoping review methodology was used to identify studies reporting on environmental impact in health economic evaluations of critical care. We searched six academic databases to locate health economic evaluations, costing studies and life cycle assessments of critical care from 1993 to present. RESULTS Four studies met the review's inclusion criteria. Of the 278 health economic evaluations of critical care identified, none incorporated environmental impact into their assessments. Most included studies (n = 3/4) were life cycle assessments, and the remaining study was a prospective observational study. Life cycle assessments used a combination of process-based data collection and modelling to incorporate environmental impact into their economic assessments. CONCLUSIONS Health economic evaluations of critical care have not yet incorporated environmental impact into their assessments, and few life cycle assessments exist that are specific to critical care therapies and treatments. Guidelines and standardisation regarding environmental data collection and reporting in health care are needed to support further research in the field. In the meantime, those planning health economic evaluations should include a process-based life cycle assessment to establish key environmental impacts specific to critical care.
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Affiliation(s)
- Alayna Carrandi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
| | - Christina Nguyen
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Wai Chung Tse
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia
- School of Medicine, Monash University, Melbourne, VIC, Australia
| | - Colman Taylor
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
| | - Forbes McGain
- Department of Critical Care, The University of Melbourne, Melbourne, VIC, Australia
- Department of Anaesthesia, Western Health, Footscray, VIC, Australia
- Department of Intensive Care, Western Health, Footscray, VIC, Australia
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Kelly Thompson
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia
- Nepean Blue Mountains Local Health District, Penrith, NSW, Australia
| | - Martin Hensher
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Scott McAlister
- School of Public Health, The University of Sydney, Sydney, NSW, Australia
- Faculty of Medicine, Dentistry and Health Sciences, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Alisa M Higgins
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Level 3, Melbourne, VIC, 3004, Australia.
- Faculty of Medicine, Critical Care Division, The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia.
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11
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Murthy S, Bernat M, Perner A. Attributable climate emissions: an important public- and patient-centered outcome for intensive care trials. Intensive Care Med 2024; 50:144-146. [PMID: 38112770 DOI: 10.1007/s00134-023-07283-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 11/15/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Srinivas Murthy
- Faculty of Medicine, University of British Columbia, Vancouver, Canada.
| | - Matthieu Bernat
- Service d'anesthésie et de Réanimation Hôpital Nord Assistance, Publique Hôpitaux Universitaires de Marseille, Aix, Marseille Université, Marseille, France
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
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12
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Bein T. Avoidance of futile treatment-confluence of human dignity and ecological ethics. Intensive Care Med 2023; 49:1145-1146. [PMID: 37548759 PMCID: PMC10499940 DOI: 10.1007/s00134-023-07173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 08/08/2023]
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13
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Bein T. [The CO 2 footprint of intensive care medicine-let's go green]. Med Klin Intensivmed Notfmed 2023:10.1007/s00063-023-01012-z. [PMID: 37119258 DOI: 10.1007/s00063-023-01012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 02/07/2023] [Accepted: 02/08/2023] [Indexed: 05/01/2023]
Abstract
Climate change and global warming are facts, and actually they are a hot topic for politics, economics, and societies. Global healthcare contributes approximately 5% of worldwide anthropogenic emissions, and this fact might produce an ethical dilemma between the Hippocratic principles of 'beneficence' (promotion of health) and of 'non-maleficence' (avoiding reinforcement of the climate crisis). Intensive care medicine has continuous high staff activity, resource use, and energy demands, and it is clear that intensive care medicine must become green to commence with practical measures to reduce their intensive care unit (ICU) carbon footprint. In this article several strategies are introduced, beginning with the creation of green teams on the ICUs from the bottom. Furthermore, systematic recycle programs, and the assessment and control of energy use are required to make ICUs more sustainable. Strategies for avoiding futile treatment combined with a choose wisely philosophy might contribute to such projects. Immediate engagement of all healthcare staff, particularly those who work in the ICU, is necessary to join the 'race to zero carbon emissions'.
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Affiliation(s)
- Thomas Bein
- Deutsche Allianz Klimawandel und Gesundheit, Fakultät für Medizin, Universität Regensburg, 93042, Regensburg, Deutschland.
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14
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Drinhaus H, Schumacher C, Drinhaus J, Wetsch WA. W(h)at(t) counts in electricity consumption in the intensive care unit. Intensive Care Med 2023; 49:437-439. [PMID: 36952015 PMCID: PMC10119198 DOI: 10.1007/s00134-023-07013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2023] [Indexed: 03/24/2023]
Affiliation(s)
- Hendrik Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany.
| | - Christine Schumacher
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
| | | | - Wolfgang A Wetsch
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Kerpener Str. 62, 50937, Cologne, Germany
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Koch S, Klitzman R. Reliance on fossil fuels: ethical implications for intensivists. Intensive Care Med 2023; 49:330-333. [PMID: 36811637 PMCID: PMC9944793 DOI: 10.1007/s00134-023-06994-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/23/2023] [Indexed: 02/24/2023]
Affiliation(s)
- Susanne Koch
- Department of Anaesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Campus Charité Mitte and Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Robert Klitzman
- Columbia University New York, Joseph Mailman School of Public Health, Master of Bioethics Program, New York, USA
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