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2026 ESAIC Consensus Document on Mitigation Strategies in Intensive Care Medicine: Consensus document of the European
Susanne Koch1, Federico Bilotta, Luca Brazzi
1From the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK) (SK), Department of Anesthesiology, Intensive Care Medicine and Pain Medicine, "Tor Vergata" University of Rome, Rome (FB), Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital (LB), Department of Surgical Science, University of Turin, Turin, Italy (LB), Department of Anaesthesia, Intensive Care and Pain Medicine, Mater Dei Hospital, Malta (AMCP), React!, Faculty of Sciences & CICA, University of A Coruña, E-15071 A Coruña, Spain (MC), Division of Anaesthesia, Analgesia, and Intensive Care - Department of Medicine and Surgery -University of Perugia Ospedale S. Maria della Misericordia, Perugia, Italy (EDR), Department of Paediatric Anaesthesia and Critical Care. La Paz University Hospital, Madrid, Spain (PGP), Department of Anaesthesiology and Intensive Care Medicine, University Medicine Greifswald, Germany (SG), Department of Anaesthesia and Intensive Care Medicine, Royal Alexandra Hospital, Paisley, Scotland, United Kingdom (PH), Department of Anesthesia, Perioperative and Pain Medicine, University of Calgary, South Health Campus, Alberta. Canada (VI), Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, and Humboldt Universität zu Berlin (SJ), University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Germany (PK), Department of Anaesthesia and Intensive Care Medicine, Medical University of Innsbruck, Innsbruck, Austria (JK), Royal Alexandra Hospital. Paisley, Scotland (PM), Department of Critical Care, King's College Hospital NHS Foundation Trust, London (VM), Centre for Education, Faculty of Life Sciences & Medicine, King's College London, Strand London, United Kingdom (VM), Department of Anaesthesia, Intensive Care and Emergency, 'Citta' della Salute e della Scienza' University Hospital (GM), Department of Surgical Science, University of Turin, Turin, Italy (GM), Department of Anaesthesia and Intensive Care, Institut Curie & PSL Research University, Research University, Paris, France (JM), Klinik für Anästhesie und Intensivmedizin, Diakonie Klinikum Stuttgart, Germany (SP), Department of Anaesthesia, Critical Care and Pain Unit, Hospital General Universitario de Valencia (CsR), Universidad Europea de Valencia, Faculty of Health, Valencia, Spain (CsR), Department of Anaesthesiology, Amsterdam University Medical Center, University of Amsterdam (NSW), Centre for Sustainable Healthcare, Amsterdam UMC, University of Amsterdam, The Netherlands (NSW), Management Engineering Faculty, Uninettuno University, Rome, Italy (AT), Department of Anaesthesiology. LMU University Hospital, LMU Munich, Germany (AT) and Division of Anaesthesiology, Intensive Care and Emergency Medicine, Department of Anaesthesiology, University Medical Center Utrecht, Utrecht, The Netherlands (WB).
Abstract:
Due to the continued use of fossil fuels and other chemical pollutants, atmospheric greenhouse gas concentrations and environmental pollution continue to rise. The health sector is both a driver and a victim of these developments, and intensive care medicine (ICM), with its high energy demands, extensive use of disposable products, and large variety of pharmaceuticals, contributes substantially to the climate crisis and environmental degradation. The European Society of Anaesthesiology and Intensive Care (ESAIC) therefore aimed to develop consensus recommendations to reduce the environmental footprint of ICM across Europe. A total of 37 recommendations were initially drafted by four topic groups (1) energy, (2) waste management, (3) medication, and (4) ethics-each composed of three to five experts. To facilitate implementation in both middle- and high-income European countries, the agreement threshold was set at 80%. The recommendations were validated by 37 experts from 20 countries using a two-step Delphi procedure. In the first round, all recommendations reached at least 75% agreement. After amendments to four recommendations based on expert feedback, all achieved over 80% approval in the second round, with 32 receiving more than 90% agreement. The final recommendations address: (1) a complete transition to renewable energy and implementation of energy-saving strategies; (2) optimisation of procurement in clinical processes (10Rs) and waste management solutions for single-use plastics; (3) reduction of greenhouse gas emissions (mainly fluorinated gases) and water toxicity caused by medications, as well as prevention of a further increase in antimicrobial resistance (AMR); and (4) implementation of an environment-related, ethically guided precautionary principle. This ESAIC consensus provides a practical framework for sustainable ICM. Stakeholders at all levels should now introduce these recommendations through institutional policies, procurement criteria, guidelines and quality improvement programmes to align intensive care practice with planetary health goals.
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