Climate change, global warming, and intensive care

Diagnostic Excellence in the Context of Climate Change: A Review

Climate change is leading to a rise in heat-related illnesses, vector-borne diseases, and numerous negative impacts on patients' physical and mental health outcomes. Concurrently, healthcare contributes about 4.6% of global greenhouse gas emissions. Low-value care, such as overtesting and overdiagnosis, contributes to unnecessary emissions. In this review, we describe diagnostic excellence in the context of climate change and focus on two topics. First, climate change is affecting health, leading to the emergence of certain diseases, some of which are new, while others are increasing in prevalence and/or becoming more widespread. These conditions will require timely and accurate diagnosis by clinicians who may not be used to diagnosing them. Second, diagnostic quality issues, such as overtesting and overdiagnosis, contribute to climate change through unnecessary emissions and waste and should be targeted for interventions. We also highlight implications for clinical practice, research, and policy. Our findings call for efforts to engage healthcare professionals and policymakers in understanding the urgent implications for diagnosis in the context of climate change and reducing global greenhouse gas emissions to enhance both patient and planetary outcomes.

The carbon footprint of critical care: a systematic review

PURPOSE

The provision of healthcare is a substantial global contributor to greenhouse gas (GHG) emissions. Several medical specialties and national health systems have begun evaluating their carbon emission contributions. The aim of this review is to summarise and describe the carbon footprint resulting from the provision of adult, paediatric and neonatal critical care.

METHODS

A systematic search of Embase, Cochrane and Web of Science was performed in January 2023. Studies reporting any assessment of the carbon footprint of critical care were included. No language restrictions were applied. GHG emissions from life cycle assessments (LCA) were reported, in addition to waste, electricity and water use. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed.

RESULTS

In total, 13 studies assessing and describing the environmental impact of 36 adult or paediatric intensive care units (ICUs) were included. Two studies described full LCAs, seven reported waste only, two provided audits of unused medical supplies, one reported electricity use, and one study described a Material Flow Analysis. The estimated carbon emissions from critical care range between 88 kg CO2e/patient/day and 178 kg CO2e/patient/day. The two predominant sources of carbon emissions in critical care originate from electricity and gas use, as well as consumables. Waste production ranged from 1.1 to 13.7 kg/patient/day in the 6 studies where mean waste could be calculated.

CONCLUSION

There is a significant carbon footprint that results from intensive care provision. Consumables and waste constitute important, measurable, and modifiable components of anthropogenic emissions. There remains uncertainty due to a lack of literature, several unstudied areas of carbon emissions from critical care units, and within measured areas, measurement and reporting of carbon emissions are inconsistent.

Increase CO2 recycling of Escherichia coli containing CBB genes by enhancing solubility of multiple expressed proteins from an operon through temperature reduction

IMPORTANCE

In a previous study, we successfully engineered Escherichia coli capable of endogenous CO2 recycling through the heterologous expression of the Calvin-Benson Bassham genes. Establishing an efficient gene expression environment for recombinant strains is crucial, on par with the importance of metabolic engineering design. Therefore, the primary objective of this study was to further mitigate greenhouse gas emissions by investigating the effects of culture temperature on the formation of inclusion bodies (IB) and CO2 fixation activity in the engineered bacterial strain. The findings demonstrate that lowering the culture temperature effectively suppresses IB formation, enhances CO2 recycling, and concurrently increases the accumulation of organic acids. This temperature control approach, without adding or modifying compounds, is both convenient and efficient for enhancing CO2 recycling. As such, additional optimization of various environmental parameters holds promise for further enhancing the performance of recombinant strains efficiently.

MULTIFACTORIAL REGRESSION MODEL FOR PREDICTING THE LEVEL OF HEAT SENSITIVITY IN HEALTHY YOUNG PEOPLE IN THE CONTEXT OF GLOBAL WARMING

OBJECTIVE

The aim: To create a mathematical model for predicting the level of heat sensitivity in healthy young people based on multivariate regression analysis.

PATIENTS AND METHODS

Materials and methods: 150 healthy young people aged 17-20 years answered the questionnaire "Levels of heat sensitivity", underwent a heat test and mathematical analysis of the heart rate, after which the results were used to build a regression model of heat sensitivity.

RESULTS

Results: The model of mathematical prediction of heat sensitivity (CHSL1/CHSL2), which we proposed for the first time, takes into account the most significant factors that influence the determination of higher and lower sensitivity to heat (Q1-Q6, %LF2, %HF1, %HF2, HR1, HR2), so its use will allow timely identi¬fication of individuals who are particularly susceptible to the effects of elevated ambient temperature and prevent the development of potential negative consequences of this exposure.

CONCLUSION

Conclusions: Based on the results obtained, it is possible to use this prognostic model in the future to develop a diagnostic system for determining the level of heat sensitivity.

Modeling coffee (Coffea arabica L.) climate suitability under current and future scenario in Jimma zone, Ethiopia

Climate suitability is important for coffee (Coffea arabica L.) production in climate variability-prone regions like Ethiopia. The aim of this study was to assess the current and future climate suitability for the species in the Jimma zone under moderate (RCP4.5) and worst (RCP8.5) climate change scenarios. Field surveys and Worldclim and Paleoclim databases were used to capture 224 C. arabica species' location points and 9 bioclimatic data, respectively. The MaxEnt model with integration of ArcGis was used to simulate and characterize these data. The diagnostic outcome of the model showed that the anticipated climate change will increase the areas of suitability in the first and third coffee sub-zones, while there will be a decrease in the second sub-zone. Net suitability under the RCP4.5 would be decreased by 4.75 and 6.09% in the 2050s and 2070s, respectively. Indeed, under the RCP8.5, total suitability will be expected to be increased by 2.52% and 2.25% in the 2050s and 2070s, respectively. For the 2050s and 2070s, the suitability gap between RCP4.5 and RCP8.5 was estimated to be 401 km² and 1567 km², respectively. To summarize, with the exemption of RCP 8.5 within the 2070s, the suitability would be improved and come up short in all circumstances. To keep Arabica coffee in its original habitat, we suggest that the entire climate change adjustment procedures that are prearranged under the RCP4.5 ought to be executed to sustain the crop trees in its origin. Otherwise, moving the crop plant from impeded areas to suitable ones is crucial.

Do Hospital Workers Feel They Are Ready to Manage a Sanitary Crisis in a Pre-Crisis Context?

OBJECTIVE

The aim of this study was to measure the perception of readiness to manage a sanitary crisis for hospital workers and to study the factors related to this perception.

METHODS

This study was a cross-sectional study; 408 French hospital workers responded to an online questionnaire. The variables studied concerned the perceived personal preparedness, the perception of colleagues' and hospital's preparedness, perception of the situation, and preparatory behavioral acts. Correlations, partial correlations, and multiple linear regressions were applied.

RESULTS

Based on Pearson's correlations, the higher the participants' sense of personal efficacy and control over their behavior, the more ready they feel (rp = 0.77*** and rp = 0.55***). The more participants perceive their colleagues as ready and their hospital as prepared, the more ready they feel (rp = 0.52*** and rp = 0.46***). Based on Pearson's partial correlations, upon controlling the effect of preparedness perception, declared preparedness is not significantly correlated with personal readiness perception (rp = 0.01).

CONCLUSION

The perception of personal readiness does not depend only on actual preparedness but also on individual and collective variables. Technically, these results confirm the value of relying on psychosocial variables during training. It would be interesting to propose empowerment in training courses. It also seems necessary to demonstrate crisis management efficacy at different levels: institutional, collective, and individual.

Pre-admission air pollution exposure prolongs the duration of ventilation in intensive care patients

Purpose

Air pollutant exposure constitutes a serious risk factor for the emergence or aggravation of (existing) pulmonary disease. The impact of pre-intensive care ambient air pollutant exposure on the duration of artificial ventilation was, however, not yet established.

Methods

The medical records of 2003 patients, admitted to the intensive care unit (ICU) of the Antwerp University Hospital (Flanders, Belgium), who were artificially ventilated on ICU admission or within 48 h after admission, for the duration of at least 48 h, were analyzed. For each patient’s home address, daily air pollutant exposure [particulate matter with an aerodynamic diameter ≤ 2.5 µm (PM_2.5) and ≤ 10 µm (PM₁₀), nitrogen dioxide (NO₂) and black carbon (BC)] up to 10 days prior to hospital admission was modeled using a high-resolution spatial–temporal model. The association between duration of artificial ventilation and air pollution exposure during the last 10 days before ICU admission was assessed using distributed lag models with a negative binomial regression fit.

Results

Controlling for pre-specified confounders, an IQR increment in BC (1.2 µg/m³) up to 10 days before admission was associated with an estimated cumulative increase of 12.4% in ventilation duration (95% CI 4.7–20.7). Significant associations were also observed for PM_2.5, PM₁₀ and NO₂, with cumulative estimates ranging from 7.8 to 8.0%.

Conclusion

Short-term ambient air pollution exposure prior to ICU admission represents an unrecognized environmental risk factor for the duration of artificial ventilation in the ICU.

Electronic supplementary material

The online version of this article (10.1007/s00134-020-05999-3) contains supplementary material, which is available to authorized users.