The carbon footprint of acute care: how energy intensive is critical care?

OBJECTIVES: Climate change has the potential to threaten human health and the environment. Managers in healthcare systems face significant challenges to balance carbon mitigation targets with operational decisions about patient care. Critical care units are major users of energy and hence more evidence is needed on their carbon footprint. STUDY DESIGN: The authors explore a methodology which estimates electricity use and associated carbon emissions within a Critical Care Unit (CCU). METHODS: A bottom-up model was developed and calibrated which predicted the electricity consumed and carbon emissions within a CCU based on the type of patients treated and working practices in a case study in Cornwall, UK. RESULTS: The model developed was able to predict the electricity consumed within CCU with an error of 1% when measured against actual meter readings. Just under half the electricity within CCU was used for delivering care to patients and monitoring their condition. CONCLUSIONS: A model was developed which accurately predicted the electricity consumed within a CCU based on patient types, medical devices used and working practice. The model could be adapted to enable it to be used within hospitals as part of their planning to meet carbon reduction targets.

An observational cohort study of triage for critical care provision during pandemic influenza: 'clipboard physicians' or 'evidenced based medicine'?

We assessed the impact of a United Kingdom government-recommended triage process, designed to guide the decision to admit patients to intensive care during an influenza pandemic, on patients in a teaching hospital intensive care unit. We found that applying the triage criteria to a current case-mix would result in 116 of the 255 patients (46%) admitted during the study period being denied intensive care treatment they would have otherwise received, of which 45 (39%) survived to hospital discharge. In turn, 69% of those categorised as too ill to warrant admission according to the criteria survived. The sensitivity and specificity of the triage category at ICU admission predicting mortality was 0.29 and 0.84, respectively. If the need for intensive care beds is estimated to be 275 patients per week, the triage criteria would not exclude enough patients to prevent the need for further rationing. We conclude that the proposed triage tool failed adequately to prioritise patients who would benefit from intensive care.

The diagnosis of acute renal failure in intensive care: mongrel or pedigree?

Acute renal failure is common in the intensive care unit; it is well recognised that patients who develop acute renal failure have a high mortality rate. While there have been improvements in the management of acute renal failure, the mortality remains high. Acute renal failure is easily diagnosed biochemically and clinically but it is not a single disease entity. It is a syndrome that affects a very heterogeneous population. Studies of acute renal failure and of the impact of renal replacement therapy in intensive care are usually inconclusive, which may be the natural consequence of studying a syndrome. This article focuses on the more uncertain features of acute renal failure, the problems of investigating acute renal failure as a disease and the difficulties of applying the results of a study of a heterogeneous population to the management of individuals.