Abstract
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 kgCO(2)e) and cost (€4), followed by BBS (2.82 kgCO(2)e, €24) and BAL (6.60 kgCO(2)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%. 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.