{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:19:50Z","timestamp":1790806790831,"version":"4.1.0"},"reference-count":41,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T00:00:00Z","timestamp":1718150400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T00:00:00Z","timestamp":1718150400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Nursing in Critical Care"],"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Healthcare's carbon footprint contributes to 4.4% of global net emissions and intensive care units (ICUs) are very resource intensive. Existing studies on environmental sustainability in ICUs focused on carbon footprint generated from energy and electricity consumption, use of medical consumables and equipment, but few studies quantified carbon footprint generated from pharmaceuticals used in ICUs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>To evaluate carbon footprint arising from sedation practices in the ICUs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>A pilot, prospective observational study was conducted in two ICUs from 1 August to 22 September 2022 in Singapore General Hospital. Adult patients who were consecutively sedated, intubated and expected to be mechanically ventilated for at least 24\u2009h were included. Total amount of analgesia and sedatives used and wasted in eligible patients were collected. Carbon emission from ICU sedation practices were then quantified using available life cycle assessment data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 31 patients were recruited. Top analgesia and sedative used in both ICUs were fentanyl and propofol, respectively. Carbon footprint from sedative usage and wastage across 7\u2009weeks in both ICUs were 2.206\u2009kg CO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010e and 0.286\u2009g CO\n                      <jats:sub>2<\/jats:sub>\n                      \u2010e, respectively. In total, this equates to driving 15.8\u2009km by car. Proportion of drug wasted ranged from 5.1% to 25.0%, with the top reason for wastage being the drug was no longer clinically indicated. Recommendations to reduce carbon footprint include choosing sedatives with lower carbon emissions where possible and having effective communication among doctors and nurses regarding management plans to minimize unnecessary wastage.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our study quantified carbon footprint arising from sedation practices, mainly drug usage and wastage in two ICUs in Singpore General Hospital.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Relevance to Clinical Practice<\/jats:title>\n                    <jats:p>Adopting a holistic approach to environmental sustainability in the ICU, sedation practices also contribute to generating greenhouse gases, albeit small, and can be targeted to reduce unnecessary carbon footprint.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/nicc.13092","type":"journal-article","created":{"date-parts":[[2024,6,12]],"date-time":"2024-06-12T21:28:56Z","timestamp":1718227736000},"page":"19-26","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Evaluating the carbon footprint of sedation practices in intensive care"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2477-8637","authenticated-orcid":false,"given":"Jie Lin","family":"Soong","sequence":"first","affiliation":[{"name":"Division of Pharmacy Singapore General Hospital  Singapore Singapore"},{"name":"Department of Pharmacy and Pharmaceutical Sciences National University of Singapore  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pei Lin","family":"Ho","sequence":"additional","affiliation":[{"name":"Division of Pharmacy Singapore General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerie Ser Hwee","family":"Neo","sequence":"additional","affiliation":[{"name":"Department of Pharmacy Ng Teng Fong General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sui An","family":"Lie","sequence":"additional","affiliation":[{"name":"Department of Surgical Intensive Care Singapore General Hospital  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,6,12]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bja.2020.12.025"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(09)60935\u20101"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(17)32464\u20109"},{"key":"e_1_2_12_5_1","volume-title":"The Climate Crisis \u2013 A Race We Can Win","author":"United Nations","year":"2022"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542\u20105196(20)30121\u20102"},{"key":"e_1_2_12_7_1","unstructured":"Health Care Without Harm.Health care climate footprint report.2023.https:\/\/noharm-global.org\/documents\/health-care-climate-footprint-report"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckaa165.843"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aan.2016.07.004"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/cc9409"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11367\u2010021\u201001998\u20108"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1441\u20102772(23)00970\u20105"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1021\/acs.est.0c02178"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjae.2022.08.005"},{"key":"e_1_2_12_15_1","unstructured":"Ellen MacArthur Foundation.What is a circular economy? A framework for an economy that is restorative and regenerative.2020.https:\/\/ellenmacarthurfoundation.org\/topics\/circular-economy-introduction\/overview"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1177\/13558196221110416"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2014.06.015"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002683"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010021\u201006455\u20106"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e31824ddfef"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1021\/acssuschemeng.8b05473"},{"key":"e_1_2_12_22_1","unstructured":"Eco\u2010Business.Here's how you can track your carbon footprint and help keep emissions low. Eco\u2010business.2020.https:\/\/www.eco-business.com\/news\/heres-how-you-can-track-your-carbon-footprint-and-help-keep-emissions-low\/"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/pst.185"},{"key":"e_1_2_12_24_1","unstructured":"Lexicomp Online. Waltham MA: UpToDate Inc.2023.https:\/\/online.lexi.com"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amsu.2021.102356"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.lanwpc.2022.100459"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.5694\/mja2.50583"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.5005\/jp\u2010journals\u201010071\u201023719"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ijcp.12941"},{"key":"e_1_2_12_30_1","unstructured":"PennyT CollinsM WhitingA Aum\u00f4nierS.Inpatient bed day module. In care pathways: guidance on appraising sustainability.2015.https:\/\/networks.sustainablehealthcare.org.uk\/sites\/default\/files\/resources\/Sustainable_Care_Pathways_Guidance_-_Main_Document_-_Oct_2015.pdf"},{"key":"e_1_2_12_31_1","unstructured":"BarrettML SmithMW ElixhauserA et al.Utilization of intensive care services 2011. 2014 Dec. in: healthcare cost and utilization project (HCUP) statistical briefs [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2006 Feb\u2013. Statistical brief #185.2023."},{"key":"e_1_2_12_32_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0000000000001227"},{"key":"e_1_2_12_33_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010019\u201005771\u20102"},{"key":"e_1_2_12_34_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010016\u20104297\u20104"},{"key":"e_1_2_12_35_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.201203\u20100522OC"},{"key":"e_1_2_12_36_1","doi-asserted-by":"publisher","DOI":"10.1097\/CCM.0b013e318232da75"},{"key":"e_1_2_12_37_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00134\u2010022\u201006940\u20106"},{"key":"e_1_2_12_38_1","doi-asserted-by":"publisher","DOI":"10.1039\/C7GC00833C"},{"key":"e_1_2_12_39_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.scp.2021.100400"},{"key":"e_1_2_12_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.aucc.2020.07.013"},{"key":"e_1_2_12_41_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1906759"},{"key":"e_1_2_12_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2009.01.003"}],"container-title":["Nursing in Critical Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.13092","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/nicc.13092","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/nicc.13092","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,12]],"date-time":"2026-04-12T05:38:41Z","timestamp":1775972321000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/nicc.13092"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,6,12]]},"references-count":41,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,1]]}},"alternative-id":["10.1111\/nicc.13092"],"URL":"https:\/\/doi.org\/10.1111\/nicc.13092","archive":["Portico"],"relation":{},"ISSN":["1362-1017","1478-5153"],"issn-type":[{"value":"1362-1017","type":"print"},{"value":"1478-5153","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,12]]},"assertion":[{"value":"2023-07-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-05-13","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-06-12","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}