Introduction: Pressurized metered-dose inhalers (MDIs) contribute to healthcare-associated greenhouse gas (GHG) emissions due to their hydrofluoroalkane (HFA) propellants. While health system-wide MDI impacts have been studied, the contribution of intensive care units (ICUs)—where rapid-acting bronchodilation is common—remains underexplored.
Methods: A retrospective analysis of inhaler use was performed at Riverside Methodist Hospital (RMH), a 1,059-bed quaternary care center with 160 adult ICU beds. Dispensing data were collected over 12 months (July 2022–June 2023) and stratified by ICU versus non-ICU locations. Greenhouse gas emissions were calculated using published carbon dioxide equivalent (CO₂e) values per inhaler: 0.0246 metric tons (MT) for budesonide-formoterol and 0.0121 MT for albuterol (200- and 60-dose). Artificial intelligence was used to support summarization and drafting of this abstract. Final content was reviewed and validated by the authors.
Results: Of 10,751 inhalers dispensed at RMH, 1,384 (12.9%) were used in ICUs, generating 28.02 MT CO₂e—13.1% of RMH’s total inhaler emissions (214.3 MT). This ICU footprint equals the energy use of 3.7 U.S. homes or 71,000 miles driven in a gasoline-powered car. ICU emissions averaged 0.175 MT CO₂e per bed annually, equating to 175 MT per 1,000 ICU beds. Combination inhalers accounted for 87% of ICU MDI emissions, highlighting opportunities for impact through targeted medication strategies.
Conclusions: Although ICUs represent only 15% of hospital beds, they contributed over 13% of inhaler-related emissions. Targeted ICU interventions—such as optimizing inhaler selection, reducing premature redispenses, and using nebulized bronchodilators when clinically appropriate—may significantly reduce environmental impact in critical care without compromising patient outcomes.
