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Choosing wisely: comparing the carbon footprint of three respiratory sampling techniques for ventilator-associated
Adam Celier1, Charlotte Correard1, Ines de Maisoncelle2
1Service de Médecine Intensive et Réanimation (Département R3S), AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, site Pitié-Salpêtrière, Paris, F-75013, France.
Background:
Intensive care units (ICU) play a significant role in healthcare global greenhouse gas emissions. Ventilator-associated pneumonia (VAP) is a common ICU-acquired infection, and while microbiological confirmation is essential, the optimal sampling method remains controversial. This study compares the carbon footprint of three diagnostic techniques for VAP-tracheal aspiration (TA), blind bronchial sampling (BBS) and bronchoalveolar lavage (BAL) using single-use bronchoscopes-while also assessing their economic cost and professional impact to support more sustainable decision-making in the ICU.
Methods:
The carbon footprint of each technique was estimated using a simplified Life Cycle Assessment (LCA) methodology via the "Carebone©" tool. Emission factors for drugs and devices were calculated. The economic costs of each procedure were also assessed. Finally, a survey of nursing staff was conducted to assess the professional impact of these techniques.
Results:
Tracheal aspiration had the lowest emissions (0.57 kgCO2e) and cost (€4), followed by BBS (2.82 kgCO2e, €24) and BAL (6.60 kgCO2e, €209). Nursing staff perceived BBS the most practical technique overall, and BAL the most technically demanding. In 2023, 341 procedures were performed in our ICU (73% BBS, 21% BAL, 6% TA), generating 1,181 kgCO2e and costing €20,835. Adopting TA exclusively in our ICU would reduce emissions by 84% and costs by 93%, whereas using BAL exclusively would increase emissions by 91% and costs by 242%.
Conclusion:
Bronchoalveolar lavage was associated with the highest carbon footprint and cost. These findings can help clinicians choose more sustainable methods for microbiological confirmation of VAP.
Insights
Tracheal aspiration (TA) is the most sustainable method for diagnosing ventilator-associated pneumonia (VAP), offering the lowest carbon footprint and cost. This study highlights TA as a greener alternative for VAP diagnosis in intensive care units (ICUs).
Area of Science:
- Environmental Science
- Healthcare Sustainability
- Infectious Disease Diagnostics
Background:
- Intensive care units (ICUs) contribute significantly to global healthcare emissions.
- Ventilator-associated pneumonia (VAP) is a prevalent ICU infection requiring microbiological confirmation.
- Current VAP diagnostic methods vary in environmental impact and cost.
Purpose of the Study:
- To compare the carbon footprint, economic cost, and professional impact of three VAP diagnostic techniques: tracheal aspiration (TA), blind bronchial sampling (BBS), and bronchoalveolar lavage (BAL).
- To provide data supporting more sustainable decision-making for VAP diagnosis in ICUs.
Main Methods:
- Life Cycle Assessment (LCA) using the Carebone© tool to estimate carbon footprint.
- Calculation of emission factors for drugs and devices.
- Assessment of economic costs for each procedure.
- Survey of nursing staff on the professional impact of each technique.
Main Results:
- Tracheal aspiration (TA) demonstrated the lowest emissions (0.57 kgCO2e) and cost (€4).
- Blind bronchial sampling (BBS) followed with 2.82 kgCO2e and €24, while bronchoalveolar lavage (BAL) had the highest impact (6.60 kgCO2e, €209).
- Exclusive adoption of TA could reduce emissions by 84% and costs by 93% in the analyzed ICU.
Conclusions:
- Bronchoalveolar lavage (BAL) presents the highest carbon footprint and economic cost among the evaluated VAP diagnostic methods.
- Tracheal aspiration (TA) emerges as a significantly more sustainable and cost-effective option.
- Findings support the selection of environmentally conscious methods for VAP microbiological confirmation.
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