The green ICU: how to interpret green? A multiple perspective approach

doi:10.1186/s13054-025-05316-8

Review

. 2025 Feb 19;29(1):80.

doi: 10.1186/s13054-025-05316-8.

The green ICU: how to interpret green? A multiple perspective approach

Elisabeth Smale¹, Heather Baid², Marko Balan³, Forbes McGain⁴, Scott McAlistar⁵, Jan J de Waele^{6

7}, Jan Carel Diehl⁸, Erik van Raaij⁹, Michel van Genderen¹, Dick Tibboel¹, Nicole Hunfeld^{10

11}

Affiliations

¹ Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
² School of Education, Sport and Health Sciences, University of Brighton, Brighton, UK.
³ Division of Critical Care, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
⁴ The Healthcare Carbon Lab, Department of Critical Care Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Western Health, Departments of Intensive Care and Anaesthesia, Melbourne, VIC, Australia.
⁶ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
⁷ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁸ Department of Sustainable Design Engineering, Delft University of Technology, Delft, The Netherlands.
⁹ Erasmus School of Health Policy & Management and Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
¹⁰ Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands. n.hunfeld@erasmusmc.nl.
¹¹ Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands. n.hunfeld@erasmusmc.nl.

PMID: 39972357
PMCID: PMC11837716
DOI: 10.1186/s13054-025-05316-8

Review

The green ICU: how to interpret green? A multiple perspective approach

Elisabeth Smale et al. Crit Care. 2025.

. 2025 Feb 19;29(1):80.

doi: 10.1186/s13054-025-05316-8.

Authors

Affiliations

¹ Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands.
² School of Education, Sport and Health Sciences, University of Brighton, Brighton, UK.
³ Division of Critical Care, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada.
⁴ The Healthcare Carbon Lab, Department of Critical Care Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, VIC, Australia.
⁵ Western Health, Departments of Intensive Care and Anaesthesia, Melbourne, VIC, Australia.
⁶ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
⁷ Department of Internal Medicine and Pediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.
⁸ Department of Sustainable Design Engineering, Delft University of Technology, Delft, The Netherlands.
⁹ Erasmus School of Health Policy & Management and Rotterdam School of Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
¹⁰ Department of Adult Intensive Care, Erasmus Medical Center, Rotterdam, The Netherlands. n.hunfeld@erasmusmc.nl.
¹¹ Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands. n.hunfeld@erasmusmc.nl.

PMID: 39972357
PMCID: PMC11837716
DOI: 10.1186/s13054-025-05316-8

Abstract

Mitigating environmental impacts is an urgent challenge supported by (scientific) intensive care societies worldwide. However, making green choices without compromising high-quality care for critically ill patients may be challenging. The current paper describes a three-step approach towards green intensive care units. Starting with the measurement of environmental sustainability, intensive care units can identify hotspots, quantify the environmental impacts of products and procedures, and monitor sustainable progress. Subsequently, a multidisciplinary approach is proposed to improve environmental sustainability, including a collaboration of procurement specialists and healthcare professionals, using co-creation and green teams as efficient grassroots change agents. A context-specific approach for enhancing sustainable healthcare practices is key in order to fit local regulatory requirements and create support of professionals. A final step is to share results and create momentum, including publishing initiatives and participating in online (inter)national networks. Based on the core sustainability principles, this three-step approach towards green ICUs provides a valuable tool to professionals worldwide to facilitate change towards environmentally responsible intensive care units.

Keywords: Environmental Impact; Intensive care unit; Multidisciplinary; Sustainability; Sustainability Transitions.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: HB has received a grant from SBRI Healthcare Competition 24 for ‘Delivering a Net Zero NHS for a Healthier Future’. FM has received royalties for a patented device for the treatment of patients with respiratory infectious diseases (the McMonty by Medihood). FM is also a founder of ReResp (developing a reusable N95 mask). JW has consulted for Biomerieux, Menarini, MSD, Pfizer, Roche Diagnostics, ThermoFisher and Viatris (fees and honoraria paid to institution). NH received grants from the Dutch Research Council for developing evidence-based Strategies to create Circular Hospitals through the 10-Rs framework (ESCH-R) and from the Netherlands Organization for Health Research and Development (ZonMw) to implement sustainability initiatives in Dutch hospitals. JDW is supported by a Sr Clinical Research Grant from the Research Foundation Flanders (FWO, Ref. 1881020N).

Figures

**Fig. 1**
Three-step approach towards green ICU’s

See this image and copyright information in PMC

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References

1. Romanello M, Walawender M, Hsu S-C, Moskeland A, Palmeiro-Silva Y, Scamman D, et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet. 2024;04(10465):1847–96. - PMC - PubMed
1. Hunfeld N, Diehl JC, Timmermann M, van Exter P, Bouwens J, Browne-Wilkinson S, et al. Circular material flow in the intensive care unit-environmental effects and identification of hotspots. Intensive Care Med. 2023;49(1):65–74. - PMC - PubMed
1. McGain F, Burnham JP, Lau R, Aye L, Kollef MH, McAlister S. The carbon footprint of treating patients with septic shock in the intensive care unit. Crit Care Resusc. 2018;20(4):304–12. - PMC - PubMed
1. Prasad PA, Joshi D, Lighter J, Agins J, Allen R, Collins M, Pena F, Velletri J, Thiel C. Environmental footprint of regular and intensive inpatient care in a large US hospital. Int J Life Cycle Assess. 2022;27(1):38–49. 10.1007/s11367-021-01998-8.
1. Ise Lau A, Burdorf SH, Wijk L, Tauber M, Hunfeld N. The carbon footprint of a Dutch academic hospital—using a hybrid assessment method to identify driving activities and departments. Front Public Health. 2024. 10.3389/fpubh.2024.1380400. - PMC - PubMed

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[1] Romanello M, Walawender M, Hsu S-C, Moskeland A, Palmeiro-Silva Y, Scamman D, et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet. 2024;04(10465):1847–96. - PMC - PubMed

[2] Romanello M, Walawender M, Hsu S-C, Moskeland A, Palmeiro-Silva Y, Scamman D, et al. The 2024 report of the Lancet Countdown on health and climate change: facing record-breaking threats from delayed action. The Lancet. 2024;04(10465):1847–96. - PMC - PubMed

[3] Hunfeld N, Diehl JC, Timmermann M, van Exter P, Bouwens J, Browne-Wilkinson S, et al. Circular material flow in the intensive care unit-environmental effects and identification of hotspots. Intensive Care Med. 2023;49(1):65–74. - PMC - PubMed

[4] Hunfeld N, Diehl JC, Timmermann M, van Exter P, Bouwens J, Browne-Wilkinson S, et al. Circular material flow in the intensive care unit-environmental effects and identification of hotspots. Intensive Care Med. 2023;49(1):65–74. - PMC - PubMed

[5] McGain F, Burnham JP, Lau R, Aye L, Kollef MH, McAlister S. The carbon footprint of treating patients with septic shock in the intensive care unit. Crit Care Resusc. 2018;20(4):304–12. - PMC - PubMed

[6] McGain F, Burnham JP, Lau R, Aye L, Kollef MH, McAlister S. The carbon footprint of treating patients with septic shock in the intensive care unit. Crit Care Resusc. 2018;20(4):304–12. - PMC - PubMed

[7] Prasad PA, Joshi D, Lighter J, Agins J, Allen R, Collins M, Pena F, Velletri J, Thiel C. Environmental footprint of regular and intensive inpatient care in a large US hospital. Int J Life Cycle Assess. 2022;27(1):38–49. 10.1007/s11367-021-01998-8.

[8] Prasad PA, Joshi D, Lighter J, Agins J, Allen R, Collins M, Pena F, Velletri J, Thiel C. Environmental footprint of regular and intensive inpatient care in a large US hospital. Int J Life Cycle Assess. 2022;27(1):38–49. 10.1007/s11367-021-01998-8.

[9] Ise Lau A, Burdorf SH, Wijk L, Tauber M, Hunfeld N. The carbon footprint of a Dutch academic hospital—using a hybrid assessment method to identify driving activities and departments. Front Public Health. 2024. 10.3389/fpubh.2024.1380400. - PMC - PubMed

[10] Ise Lau A, Burdorf SH, Wijk L, Tauber M, Hunfeld N. The carbon footprint of a Dutch academic hospital—using a hybrid assessment method to identify driving activities and departments. Front Public Health. 2024. 10.3389/fpubh.2024.1380400. - PMC - PubMed

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The green ICU: how to interpret green? A multiple perspective approach

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The green ICU: how to interpret green? A multiple perspective approach

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Conflict of interest statement

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