Critical Care
Canadian Critical Care Society
Canadian Association of Critical Care Nurses
Canadian Society of Respiratory Therapists
Last updated: August 2024
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Patients and their families often value the avoidance of invasive or overly aggressive life-sustaining measures when they are at the end of life. However, many dying patients receive aggressive life-sustaining therapies, in part due to clinicians’ failures to elicit patients’ preferences and to provide recommendations.
Sources:
Canadian Critical Care Society Ethics Committee, Bandrauk N, Downar J, Paunovic B. Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society position paper. Can J Anaesth. 2018 Jan;65(1):105-122. PMID: 29150778
Downar J, et al. Nonbeneficial treatment Canada: definitions, causes, and potential solutions from the perspective of healthcare practitioners*. Crit Care Med. 2015 Feb;43(2):270-81. PMID: 25377017.
Myburgh J, et al. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2016 Aug;34:125-30. PMID: 27288625.
Simons J, Suverein M, van Mook W, Caliskan K, Soliman O, van de Poll M, Delnoij T, Maessen J, Mees B, Lorusso R. Do-(Not-)Mechanical-Circulatory-Support Orders: Should We Ask All Cardiac Surgery Patients for Informed Consent for Post-Cardiotomy Extracorporeal Life Circulatory Support? J Clin Med. 2021 Jan 20;10(3):383. doi: 10.3390/jcm10030383. PMID: 33498412.
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Maintaining critically ill patients in an immobile or minimally mobile state during care may potentiate muscle loss and deconditioning. Excessive and/or prolonged use of sedatives is associated with worse outcomes, including increased delirium, excessive use of diagnostic imaging for coma, increased number of tracheostomies, greater duration of mechanical ventilation and ICU length-of-stay.
Sources:
Blackwood B, Tume LN, Morris KP, Clarke M, McDowell C, Hemming K, Peters MJ, McIlmurray L, Jordan J, Agus A, Murray M, Parslow R, Walsh TS, Macrae D, Easter C, Feltbower RG, McAuley DF; SANDWICH Collaborators. Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial. JAMA. 2021 Aug 3;326(5):401-410. doi: 10.1001/jama.2021.10296. PMID: 34342620.
Burry L, et al. Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation. Cochrane Database Syst Rev. 2014 Jul 9;(7):CD009176. PMID: 25005604.
Devlin JW, et al. Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018 Sep;46(9):1532-1548. PMID: 30113371
Schweickert WD, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. PMID: 19446324.
Vagionas D, Vasileiadis I, Rovina N, Alevrakis E, Koutsoukou A, Koulouris N. Daily sedation interruption and mechanical ventilation weaning: a literature review. Anaesthesiol Intensive Ther. 2019;51(5):380-389. PMID: 31893604.
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Screening for readiness for liberation from mechanical ventilation with spontaneous breathing trials allows clinicians earlier recognition of patients that may be liberated from mechanical ventilation.
Sources:
Girard TD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008 Jan 12;371(9607):126-34. PMID: 18191684.
Girard TD et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med. 2017 Jan 1;195(1):120-133. PMID: 27762595
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Chest radiographs (“X-rays”, CXRs) are not indicated for routine assessment of critically-ill patients except following specific procedures (e.g., endotracheal tube, naso- or orogastric tube, central vein catheter, or other procedure requiring verification after insertion), or to provide information for a specific question related to a change in patient’s clinical condition. This includes during cases of suspected or confirmed COVID-19. Blood tests should be ordered to monitor a specific clinical condition, or to answer a specific clinical question. At a minimum, the need for recurring or repetitive blood tests should be reassessed daily.
Sources:
Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD. ACR appropriateness criteria routine chest radiographs in intensive care unit patients. J Am Coll Radiol. 2013 Mar;10(3):170-4. PMID: 23571057.
Ganapathy A, et al. Routine chest x-rays in intensive care units: a systematic review and meta-analysis. Crit Care. 2012 Dec 12;16(2):R68. PMID: 22541022.
Eaton KP et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Intern Med. 2017;177(12):1833-9. PMID: 29049500.
Kotecha N et al. Reducing Unnecessary Laboratory Testing in the Medical ICU. Am J Med. 2017 Jun;130(6):648-651. PMID: 28285068
Routine Blood Tests for Patients in the Intensive Care Unit: Clinical Effectiveness, Cost-Effectiveness, and Guidelines. CADTH. August 16, 2013
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Unnecessary transfusion of red blood cells (RBCs) is more harmful than helpful, and wastes a limited resource, which should be reserved for patients with proven indications. Transfusing RBCs at a threshold higher than 70 g/L does not improve survival in ICU patients, and is associated with more complications and higher costs. This has been extensively studied and a restrictive transfusion strategy results in similar or lower mortality compared with higher thresholds, and other complications, including stroke and infections, may also be reduced.
Sources:
Abbasciano RG, Yusuff H, Vlaar APJ, Lai F, Murphy GJ. Blood Transfusion Threshold in Patients Receiving Extracorporeal Membrane Oxygenation Support for Cardiac and Respiratory Failure-A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2021;35(4):1192-1202. PMID: 33046363.
Carson JL, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016 Nov 15;316(19):2025-2035. PMID: 27732721.
Consensus recommendations for red blood cell transfusion practice in critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018; 19(9): 884-898. PMID: 30180125.
Mistry N, Shehata N, Carmona P, Bolliger D, Hu R, Carrier FM, Alphonsus CS, Tseng EE, Royse AG, Royse C, Filipescu D, Mehta C, Saha T, Villar JC, Gregory AJ, Wijeysundera DN, Thorpe KE, Jüni P, Hare GMT, Ko DT, Verma S, Mazer CD; TRICS Investigators. Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open-label, randomized, blinded outcome evaluation trial. Diabetes Obes Metab. 2022 Mar;24(3):421-431. doi: 10.1111/dom.14591. Epub 2021 Nov 17. PMID: 34747087.
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Gloves don’t need to be used for most routine healthcare interactions with certain exceptions. Unnecessary use of gloves is common, leads to increased costs, generates waste and may inadvertently increase rates of cross-contamination. A study in the Netherlands found that >100 disposable gloves were used in the ICU per patient per day contributing to the highest carbon footprint compared to other commonly used products.
Sources:
Canada’s Drug and Health Technology Agency (2023). CADTH Health Technology Review: Non-sterile glove use.
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 Medicine. 2023;49(1):65-74. PMID: 36480046.
Loveday HP, Lynam S, Singleton J, Wilson J. Clinical glove use: healthcare workers’ actions and perceptions. J Hosp Infect. 2014 Feb;86(2):110-6. doi: 10.1016/j.jhin.2013.11.003. Epub 2013 Nov 28. PMID: 24412643.
World Health Organization (2009). Glove use information leaflet.
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Less frequent ventilator tubing or in-line suction catheter changes have been shown to result in equal or lower rates of ventilator-associated pneumonia. Current guidelines suggest circuit changes on an as needed basis rather than a more frequent or fixed replacement schedule.
Sources:
Canada’s Drug and Health Technology Agency (2023 September). CADTH Health Technology Review: Timing of Ventilator Circuit Tubing Replacement.
Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology. 2022;43(6):687-713. doi:10.1017/ice.2022.88. PMID: 3558909.
Kollef MH, Prentice D, Shapiro SD, Fraser VJ, Silver P, Trovillion E, et al., (1997). Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med, 156:466-472. PMID: 9279225.
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Disposal of unused medical supplies is common in ICUs, particularly at the time of patient transfer. Practices such as centralized supply carts, as-needed in-room restocking, and keeping emergency medication immediately available but unopened, have been suggested to minimize waste generated from unused items.
Sources:
ANZICS (2020). A beginners guide to sustainability in the ICU.
Ghersin, Zelda J. ; Flaherty, Michael R. ; Yager, Phoebe ; Cummings, Brian M. Routledge Going green: decreasing medical waste in a paediatric intensive care unit in the United States. The new bioethics, 2020-04, Vol.26 (2), p.98-110. PMID: 32597343.
Morrow, J., Hunt, S., Rogan, V., Cowie, K., Kopacz, J., Keeler, C., Billick, M. B., & Kroh, M. (2013). Reducing waste in the critical care setting. Nursing leadership (Toronto, Ont.), 26 Spec No 2013, 17–26. https://doi.org/10.12927/cjnl.2013.23362. PMID: 24860948.
Yu, A., & Baharmand, I. (2021). Environmental Sustainability in Canadian Critical Care: A Nationwide Survey Study on Medical Waste Management. Healthcare Quarterly (Toronto, Ont.). 23(4), 39–45. https://doi.org/10.12927/hcq.2020.26394. PMID: 33475491.
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Intravenous medication administration requires additional equipment including syringes, IV tubing, and/or IV bags, may increase the carbon footprint and negatively affect planetary health, as compared to enteral administration. Intravenous antibiotics have been found to have 10-70 times greater carbon footprint than the equivalent oral form. Several medications may be equally safe and effective when administered enterally including antimicrobials, gastric acid suppressing medications, anti-epileptic medications and pain medications.
Sources:
Debra A. Goff, Karri A. Bauer, Erica E. Reed, Kurt B. Stevenson, Jeremy J. Taylor, Jessica E. West, Is the “Low-Hanging Fruit” Worth Picking for Antimicrobial Stewardship Programs?, Clinical Infectious Diseases, Volume 55, Issue 4, 15 August 2012, Pages 587–592, https://doi.org/10.1093/cid/cis494. PMID: 22615329.
Gasparetto, J., Tuon, F. F., Dos Santos Oliveira, D., Zequinao, T., Pipolo, G. R., Ribeiro, G. V., Benincá, P. D., Cruz, J. A. W., & Moraes, T. P. (2019). Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC infectious diseases, 19(1), 650. https://doi.org/10.1186/s12879-019-4280-0. PMID: 31331272.
Olsen, K. M., & Devlin, J. W. (2008). Comparison of the enteral and intravenous lansoprazole pharmacodynamic responses in critically ill patients. Alimentary pharmacology & therapeutics, 28(3), 326-333. PMID: 19086331.
Walpole S, Eii M, Aldridge C. Medicines are responsible for 22% of the NHS’s Carbon Footprint: How do the footprints of intravenous and oral antibiotics compare? Federation of Infection Societies Conference abstract. 2021.
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Several studies have found decreased overall environmental costs with reusable equipment as compared to single-use disposable equipment. Some examples relevant to critical care include laryngoscopy handles and blades, blood pressure cuffs, pulse oximeters and sterile surgical/procedural gowns and drapes. The benefit however is not universal for all equipment or ICUs and depends on local practices and hospital electricity source and sterilization practices.
Sources:
Duffy J, Slutzman JE, Thiel CL, Landes M. Sustainable Purchasing Practices: A Comparison of Single-use and Reusable Pulse Oximeters in the Emergency Department. West J Emerg Med. 2023 Nov;24(6):1034-1042. PMID: 38165184.
McGain, F, McAlister, S. Reusable versus single-use ICU equipment: what’s the environmental footprint?. Intensive Care Med 49, 1523–1525 (2023). PMID:37962641.
McGain F, McAlister S, McGavin A, Story D. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesth Analg. 2012 May;114(5):1073-80. Epub 2012 Apr 4. PMID: 22492185
Overcash, M. A Comparison of Reusable and Disposable Perioperative Textiles: Sustainability State-of-the-Art 2012. Anesthesia & Analgesia 114(5):p 1055-1066, May 2012. PMID: 22492184.
Sanchez, SA, Eckelman MJ, Sherman, JD. Environmental and economic comparison of reusable and disposable blood pressure cuffs in multiple clinical settings, Resources, Conservation and Recycling, Volume 155, 2020, 104643, ISSN 0921-3449, https://doi.org/10.1016/j.resconrec.2019.104643.
Sherman, J, Raibley, LA, Eckelman, MJ. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes. Anesthesia & Analgesia 127(2):p 434-443, August 2018. PMID: 29324492.
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Supplies used for isolation precautions contribute to waste generated in ICUs. Eliminating no longer necessary isolation/infectious precautions reduces this waste and consequently the carbon footprint of ICUs.
Sources:
Anstey MH, Trent L, Bhonagiri D, Hammond NE, Knowles S, McGain F; George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group; Steering Committee members; Coordinating centre List of investigators; Site List of investigators. How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs. Crit Care Resusc. 2023 Jun 26;25(2):78-83. PMID: 37876601.
Hunfeld N, Diehl JC, Timmermann M, van Exter P, Bouwens J, Browne-Wilkinson S, de Planque N, Gommers D. Circular material flow in the intensive care unit-environmental effects and identification of hotspots. Intensive Care Med. 2023 Jan;49(1):65-74. Epub 2022 Dec 8. PMID: 36480046.
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Continuing unnecessary medications after a patient’s ICU stay exposes them to risks and contributes to an increased carbon footprint and waste generation. Medications make up a significant contribution to the carbon footprint of healthcare in general, and in the ICU.
Sources:
Baid H, Damm E, Trent L, McGain F. Towards net zero: critical care. BMJ. 2023 Jun 1;381:e069044. PMID: 37263670.
Bosma LBE, Hunfeld NGM, Quax RAM, Meuwese E, Melief PHGJ, van Bommel J, Tan S, van Kranenburg MJ, van den Bemt PMLA. The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design. Ann Intensive Care. 2018 Feb 7;8(1):19. PMID: 29417295.
Gaetani, M, Uleryk, E, Halgren, C. et al. The carbon footprint of critical care: a systematic review. Intensive Care Med 50, 731–745 (2024). PMID: 38416200.
NHS England (1 October 2020). Delivering a ‘Net Zero’ National Health Service. NHS.
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The Choosing Wisely Canada list of recommendations relevant to critical care was assembled by a collaborative task force from Canadian Critical Care Society (CCCS), Canadian Association of Critical Care Nurses, Canadian Society of Respiratory Therapists and representatives from pharmacy, dietician and physiotherapy. The initial list of items were generated by task force, with support from CCCS Google groups. A modified Delphi method was used to retain 10 items from the initial list. A modified Delphi method was then used to generate domains of interest for ranking items and to select the final list of 5 items. Members of all collaborating societies were surveyed during the 2016 Canadian Critical Care Conference, and for 2 weeks afterwards. Items were modified after review of the survey and feedback from the Choosing Wisely Canada campaign leadership.
Sources:
Canadian Critical Care Society Ethics Committee, Bandrauk N, Downar J, Paunovic B. Withholding and withdrawing life-sustaining treatment: The Canadian Critical Care Society position paper. Can J Anaesth. 2018 Jan;65(1):105-122. PMID: 29150778
Downar J, et al. Nonbeneficial treatment Canada: definitions, causes, and potential solutions from the perspective of healthcare practitioners*. Crit Care Med. 2015 Feb;43(2):270-81. PMID: 25377017.
Myburgh J, et al. End-of-life care in the intensive care unit: Report from the Task Force of World Federation of Societies of Intensive and Critical Care Medicine. J Crit Care. 2016 Aug;34:125-30. PMID: 27288625.
Simons J, Suverein M, van Mook W, Caliskan K, Soliman O, van de Poll M, Delnoij T, Maessen J, Mees B, Lorusso R. Do-(Not-)Mechanical-Circulatory-Support Orders: Should We Ask All Cardiac Surgery Patients for Informed Consent for Post-Cardiotomy Extracorporeal Life Circulatory Support? J Clin Med. 2021 Jan 20;10(3):383. doi: 10.3390/jcm10030383. PMID: 33498412.
Blackwood B, Tume LN, Morris KP, Clarke M, McDowell C, Hemming K, Peters MJ, McIlmurray L, Jordan J, Agus A, Murray M, Parslow R, Walsh TS, Macrae D, Easter C, Feltbower RG, McAuley DF; SANDWICH Collaborators. Effect of a Sedation and Ventilator Liberation Protocol vs Usual Care on Duration of Invasive Mechanical Ventilation in Pediatric Intensive Care Units: A Randomized Clinical Trial. JAMA. 2021 Aug 3;326(5):401-410. doi: 10.1001/jama.2021.10296. PMID: 34342620.
Burry L, et al. Daily sedation interruption versus no daily sedation interruption for critically ill adult patients requiring invasive mechanical ventilation. Cochrane Database Syst Rev. 2014 Jul 9;(7):CD009176. PMID: 25005604.
Devlin JW, et al. Executive Summary: Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU. Crit Care Med. 2018 Sep;46(9):1532-1548. PMID: 30113371
Schweickert WD, et al. Early physical and occupational therapy in mechanically ventilated, critically ill patients: a randomised controlled trial. Lancet. 2009 May 30;373(9678):1874-82. PMID: 19446324.
Vagionas D, Vasileiadis I, Rovina N, Alevrakis E, Koutsoukou A, Koulouris N. Daily sedation interruption and mechanical ventilation weaning: a literature review. Anaesthesiol Intensive Ther. 2019;51(5):380-389. PMID: 31893604.
Girard TD, et al. Efficacy and safety of a paired sedation and ventilator weaning protocol for mechanically ventilated patients in intensive care (Awakening and Breathing Controlled trial): a randomised controlled trial. Lancet. 2008 Jan 12;371(9607):126-34. PMID: 18191684.
Girard TD et al. An Official American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Rehabilitation Protocols, Ventilator Liberation Protocols, and Cuff Leak Tests. Am J Respir Crit Care Med. 2017 Jan 1;195(1):120-133. PMID: 27762595
Amorosa JK, Bramwit MP, Mohammed TL, Reddy GP, Brown K, Dyer DS, Ginsburg ME, Heitkamp DE, Jeudy J, Kirsch J, MacMahon H, Ravenel JG, Saleh AG, Shah RD. ACR appropriateness criteria routine chest radiographs in intensive care unit patients. J Am Coll Radiol. 2013 Mar;10(3):170-4. PMID: 23571057.
Ganapathy A, et al. Routine chest x-rays in intensive care units: a systematic review and meta-analysis. Crit Care. 2012 Dec 12;16(2):R68. PMID: 22541022.
Eaton KP et al. Evidence-based guidelines to eliminate repetitive laboratory testing. JAMA Intern Med. 2017;177(12):1833-9. PMID: 29049500.
Kotecha N et al. Reducing Unnecessary Laboratory Testing in the Medical ICU. Am J Med. 2017 Jun;130(6):648-651. PMID: 28285068
Routine Blood Tests for Patients in the Intensive Care Unit: Clinical Effectiveness, Cost-Effectiveness, and Guidelines. CADTH. August 16, 2013
Abbasciano RG, Yusuff H, Vlaar APJ, Lai F, Murphy GJ. Blood Transfusion Threshold in Patients Receiving Extracorporeal Membrane Oxygenation Support for Cardiac and Respiratory Failure-A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth. 2021;35(4):1192-1202. PMID: 33046363.
Carson JL, et al. Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA. 2016 Nov 15;316(19):2025-2035. PMID: 27732721.
Consensus recommendations for red blood cell transfusion practice in critically ill children from the Pediatric Critical Care Transfusion and Anemia Expertise Initiative. Pediatr Crit Care Med 2018; 19(9): 884-898. PMID: 30180125.
Mistry N, Shehata N, Carmona P, Bolliger D, Hu R, Carrier FM, Alphonsus CS, Tseng EE, Royse AG, Royse C, Filipescu D, Mehta C, Saha T, Villar JC, Gregory AJ, Wijeysundera DN, Thorpe KE, Jüni P, Hare GMT, Ko DT, Verma S, Mazer CD; TRICS Investigators. Restrictive versus liberal transfusion in patients with diabetes undergoing cardiac surgery: An open-label, randomized, blinded outcome evaluation trial. Diabetes Obes Metab. 2022 Mar;24(3):421-431. doi: 10.1111/dom.14591. Epub 2021 Nov 17. PMID: 34747087.
Canada’s Drug and Health Technology Agency (2023). CADTH Health Technology Review: Non-sterile glove use.
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 Medicine. 2023;49(1):65-74. PMID: 36480046.
Loveday HP, Lynam S, Singleton J, Wilson J. Clinical glove use: healthcare workers’ actions and perceptions. J Hosp Infect. 2014 Feb;86(2):110-6. doi: 10.1016/j.jhin.2013.11.003. Epub 2013 Nov 28. PMID: 24412643.
World Health Organization (2009). Glove use information leaflet.
Canada’s Drug and Health Technology Agency (2023 September). CADTH Health Technology Review: Timing of Ventilator Circuit Tubing Replacement.
Klompas M, Branson R, Cawcutt K, et al. Strategies to prevent ventilator-associated pneumonia, ventilator-associated events, and nonventilator hospital-acquired pneumonia in acute-care hospitals: 2022 Update. Infection Control & Hospital Epidemiology. 2022;43(6):687-713. doi:10.1017/ice.2022.88. PMID: 3558909.
Kollef MH, Prentice D, Shapiro SD, Fraser VJ, Silver P, Trovillion E, et al., (1997). Mechanical ventilation with or without daily changes of in-line suction catheters. Am J Respir Crit Care Med, 156:466-472. PMID: 9279225.
ANZICS (2020). A beginners guide to sustainability in the ICU.
Ghersin, Zelda J. ; Flaherty, Michael R. ; Yager, Phoebe ; Cummings, Brian M. Routledge Going green: decreasing medical waste in a paediatric intensive care unit in the United States. The new bioethics, 2020-04, Vol.26 (2), p.98-110. PMID: 32597343.
Morrow, J., Hunt, S., Rogan, V., Cowie, K., Kopacz, J., Keeler, C., Billick, M. B., & Kroh, M. (2013). Reducing waste in the critical care setting. Nursing leadership (Toronto, Ont.), 26 Spec No 2013, 17–26. https://doi.org/10.12927/cjnl.2013.23362. PMID: 24860948.
Yu, A., & Baharmand, I. (2021). Environmental Sustainability in Canadian Critical Care: A Nationwide Survey Study on Medical Waste Management. Healthcare Quarterly (Toronto, Ont.). 23(4), 39–45. https://doi.org/10.12927/hcq.2020.26394. PMID: 33475491.
Debra A. Goff, Karri A. Bauer, Erica E. Reed, Kurt B. Stevenson, Jeremy J. Taylor, Jessica E. West, Is the “Low-Hanging Fruit” Worth Picking for Antimicrobial Stewardship Programs?, Clinical Infectious Diseases, Volume 55, Issue 4, 15 August 2012, Pages 587–592, https://doi.org/10.1093/cid/cis494. PMID: 22615329.
Gasparetto, J., Tuon, F. F., Dos Santos Oliveira, D., Zequinao, T., Pipolo, G. R., Ribeiro, G. V., Benincá, P. D., Cruz, J. A. W., & Moraes, T. P. (2019). Intravenous-to-oral antibiotic switch therapy: a cross-sectional study in critical care units. BMC infectious diseases, 19(1), 650. https://doi.org/10.1186/s12879-019-4280-0. PMID: 31331272.
Olsen, K. M., & Devlin, J. W. (2008). Comparison of the enteral and intravenous lansoprazole pharmacodynamic responses in critically ill patients. Alimentary pharmacology & therapeutics, 28(3), 326-333. PMID: 19086331.
Walpole S, Eii M, Aldridge C. Medicines are responsible for 22% of the NHS’s Carbon Footprint: How do the footprints of intravenous and oral antibiotics compare? Federation of Infection Societies Conference abstract. 2021.
Duffy J, Slutzman JE, Thiel CL, Landes M. Sustainable Purchasing Practices: A Comparison of Single-use and Reusable Pulse Oximeters in the Emergency Department. West J Emerg Med. 2023 Nov;24(6):1034-1042. PMID: 38165184.
McGain, F, McAlister, S. Reusable versus single-use ICU equipment: what’s the environmental footprint?. Intensive Care Med 49, 1523–1525 (2023). PMID:37962641.
McGain F, McAlister S, McGavin A, Story D. A life cycle assessment of reusable and single-use central venous catheter insertion kits. Anesth Analg. 2012 May;114(5):1073-80. Epub 2012 Apr 4. PMID: 22492185
Overcash, M. A Comparison of Reusable and Disposable Perioperative Textiles: Sustainability State-of-the-Art 2012. Anesthesia & Analgesia 114(5):p 1055-1066, May 2012. PMID: 22492184.
Sanchez, SA, Eckelman MJ, Sherman, JD. Environmental and economic comparison of reusable and disposable blood pressure cuffs in multiple clinical settings, Resources, Conservation and Recycling, Volume 155, 2020, 104643, ISSN 0921-3449, https://doi.org/10.1016/j.resconrec.2019.104643.
Sherman, J, Raibley, LA, Eckelman, MJ. Life Cycle Assessment and Costing Methods for Device Procurement: Comparing Reusable and Single-Use Disposable Laryngoscopes. Anesthesia & Analgesia 127(2):p 434-443, August 2018. PMID: 29324492.
Anstey MH, Trent L, Bhonagiri D, Hammond NE, Knowles S, McGain F; George Institute for Global Health and the Australian and New Zealand Intensive Care Society Clinical Trials Group; Steering Committee members; Coordinating centre List of investigators; Site List of investigators. How much do we throw away in the intensive care unit? An observational point prevalence study of Australian and New Zealand ICUs. Crit Care Resusc. 2023 Jun 26;25(2):78-83. PMID: 37876601.
Hunfeld N, Diehl JC, Timmermann M, van Exter P, Bouwens J, Browne-Wilkinson S, de Planque N, Gommers D. Circular material flow in the intensive care unit-environmental effects and identification of hotspots. Intensive Care Med. 2023 Jan;49(1):65-74. Epub 2022 Dec 8. PMID: 36480046.
Baid H, Damm E, Trent L, McGain F. Towards net zero: critical care. BMJ. 2023 Jun 1;381:e069044. PMID: 37263670.
Bosma LBE, Hunfeld NGM, Quax RAM, Meuwese E, Melief PHGJ, van Bommel J, Tan S, van Kranenburg MJ, van den Bemt PMLA. The effect of a medication reconciliation program in two intensive care units in the Netherlands: a prospective intervention study with a before and after design. Ann Intensive Care. 2018 Feb 7;8(1):19. PMID: 29417295.
Gaetani, M, Uleryk, E, Halgren, C. et al. The carbon footprint of critical care: a systematic review. Intensive Care Med 50, 731–745 (2024). PMID: 38416200.
NHS England (1 October 2020). Delivering a ‘Net Zero’ National Health Service. NHS.
About Choosing Wisely Canada
Choosing Wisely Canada is the national voice for reducing unnecessary tests and treatments in health care. One of its important functions is to help clinicians and patients engage in conversations that lead to smart and effective care choices.
Web: choosingwiselycanada.org
Email: info@choosingwiselycanada.org
Twitter: @ChooseWiselyCA
Facebook: /ChoosingWiselyCanada
Using Blood Wisely
A national campaign that aims to reduce unnecessary red blood cell transfusions in hospital settings.