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Background <p>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.</p> Methods <p>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.</p> Results <p>Tracheal aspiration had the lowest emissions (0.57 kgCO<sub>2</sub>e) and cost (€4), followed by BBS (2.82 kgCO<sub>2</sub>e, €24) and BAL (6.60 kgCO<sub>2</sub>e, €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%.</p> Conclusion <p>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.</p>

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Choosing wisely: comparing the carbon footprint of three respiratory sampling techniques for ventilator-associated pneumonia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月8日

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  • Adam Celier,
  • Charlotte Correard,
  • Ines de Maisoncelle,
  • Eric Dupont,
  • Alexandre Demoule,
  • Marie Lecronier

摘要

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.