Environmental sustainability in intensive care: the path forward. An ESICM Green Paper

Jan J De Waele^{1

2}, Nicole Hunfeld^{3

4}, Heather Baid⁵, Ricard Ferrer^{6

7}, Katerina Iliopoulou^{8

9}, Ana-Maria Ioan¹⁰, Marc Leone¹¹, Marlies Ostermann^{12

13}, Gaetano Scaramuzzo^{14

15}, Maria Theodorakopoulou^{16

17}, Hugo Touw¹⁸, Giuseppe Citerio^{19

20}, Lennie P G Derde²¹, Katia Donadello^{22

23}, Nicole P Juffermans²⁴, Laura Galarza²⁵, Giacomo Grasselli^{26

27}, Salvatore Maurizio Maggiore^{28

29}, Ignacio Martin-Loeches^{30

31

32}, Joel Alexandre³³, Maurizio Cecconi^{34

35}, Elie Azoulay³⁶

Affiliations

¹ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Jan.DeWaele@UGent.be.
² Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Jan.DeWaele@UGent.be.
³ Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁵ University of Brighton, Brighton, UK.
⁶ Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁷ SODIR Research Group, VHIR Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁸ City University of London, London, UK.
⁹ Hellenic National Public Health Organisation, Athens, Greece.
¹⁰ Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
¹¹ Service d'Anesthesie et de Réanimation, hôpital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille Université, Marseille, France.
¹² Department of Critical Care, Guy's & St Thomas' Hospital, London, UK.
¹³ King's College London, London, UK.
¹⁴ Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
¹⁵ Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
¹⁶ General Hospital of Attiki KAT, Athens, Greece.
¹⁷ National and Kapodistrian University Of Athens Medical School, Athens, Greece.
¹⁸ Radboud University Medical Centre, Nijmegen, The Netherlands.
¹⁹ School of Medicine and Surgery, Milano - Bicocca University, Milan, Italy.
²⁰ Neurointensive Care Unit, fondazione IRCCS San Gerardo, Monza, Italy.
²¹ Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands.
²² Department of Surgery, Dentistry, Gynaecology And Paesiatrics, University of Verona, Verona, Italy.
²³ Anaesthedia and Intensive Care B, University Hospital Integrated Trust of Verona, Verona, Italy.
²⁴ Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.
²⁵ Department of Intensive Care, Hospital General Universitario de Castellón, Castellón de La Plana, Spain.
²⁶ Department of Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²⁷ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
²⁸ University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
²⁹ Department of Anesthesiology, Critical Care Medicine, and Emergency, SS Annunziata Hospital, Chieti, Italy.
³⁰ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James Hospital, Dublin, Ireland.
³¹ Department of Pneumology, Hospital Clinic of Barcelona-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain.
³² CIBERES, ISCIII, Barcelona, Spain.
³³ European Society of Intensive Care Medicine, Brussels, Belgium.
³⁴ Biomedical Sciences Department, Humanitas University, Milan, Italy.
³⁵ Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
³⁶ Critical Care Department, APHP, Hôpital Saint-Louis, Paris Cité University, Paris, France.

PMID: 39377790
PMCID: PMC11541358
DOI: 10.1007/s00134-024-07662-7

Environmental sustainability in intensive care: the path forward. An ESICM Green Paper

Jan J De Waele et al. Intensive Care Med. 2024 Nov.

. 2024 Nov;50(11):1729-1739.

doi: 10.1007/s00134-024-07662-7. Epub 2024 Oct 8.

Authors

Affiliations

¹ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium. Jan.DeWaele@UGent.be.
² Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium. Jan.DeWaele@UGent.be.
³ Department of Intensive Care, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁴ Department of Hospital Pharmacy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
⁵ University of Brighton, Brighton, UK.
⁶ Intensive Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁷ SODIR Research Group, VHIR Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain.
⁸ City University of London, London, UK.
⁹ Hellenic National Public Health Organisation, Athens, Greece.
¹⁰ Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
¹¹ Service d'Anesthesie et de Réanimation, hôpital Nord, Assistance Publique Hôpitaux Universitaires de Marseille, Aix Marseille Université, Marseille, France.
¹² Department of Critical Care, Guy's & St Thomas' Hospital, London, UK.
¹³ King's College London, London, UK.
¹⁴ Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
¹⁵ Department of Emergency, Azienda Ospedaliera Universitaria Sant'Anna, Ferrara, Italy.
¹⁶ General Hospital of Attiki KAT, Athens, Greece.
¹⁷ National and Kapodistrian University Of Athens Medical School, Athens, Greece.
¹⁸ Radboud University Medical Centre, Nijmegen, The Netherlands.
¹⁹ School of Medicine and Surgery, Milano - Bicocca University, Milan, Italy.
²⁰ Neurointensive Care Unit, fondazione IRCCS San Gerardo, Monza, Italy.
²¹ Intensive Care Center, University Medical Center Utrecht, Utrecht, The Netherlands.
²² Department of Surgery, Dentistry, Gynaecology And Paesiatrics, University of Verona, Verona, Italy.
²³ Anaesthedia and Intensive Care B, University Hospital Integrated Trust of Verona, Verona, Italy.
²⁴ Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.
²⁵ Department of Intensive Care, Hospital General Universitario de Castellón, Castellón de La Plana, Spain.
²⁶ Department of Emergency, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
²⁷ Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
²⁸ University Department of Innovative Technologies in Medicine and Dentistry, Gabriele d'Annunzio University of Chieti-Pescara, Chieti, Italy.
²⁹ Department of Anesthesiology, Critical Care Medicine, and Emergency, SS Annunziata Hospital, Chieti, Italy.
³⁰ Department of Intensive Care Medicine, Multidisciplinary Intensive Care Research Organization (MICRO), St. James Hospital, Dublin, Ireland.
³¹ Department of Pneumology, Hospital Clinic of Barcelona-August Pi i Sunyer Biomedical Research Institute (IDIBAPS), University of Barcelona, Barcelona, Spain.
³² CIBERES, ISCIII, Barcelona, Spain.
³³ European Society of Intensive Care Medicine, Brussels, Belgium.
³⁴ Biomedical Sciences Department, Humanitas University, Milan, Italy.
³⁵ Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
³⁶ Critical Care Department, APHP, Hôpital Saint-Louis, Paris Cité University, Paris, France.

PMID: 39377790
PMCID: PMC11541358
DOI: 10.1007/s00134-024-07662-7

Abstract

Purpose: The European Society of Intensive Care Medicine (ESICM) Green Paper aims to address the challenge of environmental sustainability in intensive care and proposes actionable strategies for integrating sustainability into intensive care unit (ICU) stakeholder actions.

Methods: The ESICM Executive Committee appointed a task force of topic experts and ESICM committee representatives to develop the ESICM Green Paper. The task force convened biweekly from January to June 2024, identifying key domains for environmental sustainability and prioritizing actions. Drafts were iteratively refined and approved by the ESICM Executive Committee.

Results: Climate change will impact activities in intensive care in many ways, but also the impact of ICU activities on the environment is considerable; drivers for this include extensive resource use and waste generation in ICUs from energy consumption, use of disposable items, and advanced therapies for critically ill patients. The ESICM Green Paper outlines a structured approach for ICUs to reduce their environmental impact, emphasizing energy efficiency, waste reduction, and sustainable procurement. Furthermore, it endorses the need for awareness and education among healthcare professionals, integration of sustainability into research, and sustainable policies within scientific societies.

Conclusions: The ESICM Green Paper reviewed the relevance of climate change to intensive care and provided suggestions for clinical practice, research, education, and ESICM organizational domains. It underscores that reducing intensive care's ecological footprint can coexist with high-quality patient care. Promoting a resilient, responsible healthcare system is a joint responsibility of all ICU stakeholders.

Keywords: Climate change; Energy efficiency; Environmental sustainability; Intensive care; Procurement; Resource consumption; Waste management.

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Conflict of interest statement

HB has received grants from SBRI Healthcare Competition 24 for ‘Delivering a Net Zero NHS for a Healthier Future’ NH has received grants from NWO (Dutch Research Agenda) for ESCH-R project involving circular hospitals and from Erasmus MC grant for Zero Emission Endoscopy project. HT has received grants from ZonMw (Climate and Health). The other Authors declare no conflicts of interest.

Figures

**Fig. 1**
The four domains relevant to environmental sustainability in intensive care with key actions identified. *ICU* intensive care unit, *HCP* healthcare professional

See this image and copyright information in PMC

References

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Environmental sustainability in intensive care: the path forward. An ESICM Green Paper

Affiliations

Environmental sustainability in intensive care: the path forward. An ESICM Green Paper

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

MeSH terms

LinkOut - more resources

Full Text Sources

Medical