Global environmental and geo-economic impact of conservative versus liberal oxygen strategies in mechanically ventilated critically ill adults: an ecological country-level analysis.

Authors

Kasim Allel, Sebastian Morales, Gerard A Jaoude, Roque Basoalto, Hassan Haghparast-Bidgoli, Jaime Retamal, Juliana C Ferreira, Elisabeth Riviello, Eduardo Kattan

Published in

British journal of anaesthesia. Jul 01, 2026. Epub Jul 01, 2026.

Abstract

Although conservative and liberal oxygenation targets yield similar clinical outcomes in mechanically ventilated critically ill adults, the global environmental and economic implications remain unknown.
We conducted an ecological analysis using 2024 country-level aggregate data for 200 countries. Conservative (peripheral O₂ saturation, SpO₂ 88-92%) and liberal (SpO₂ ≥96%) oxygenation targets were selected using data from a randomised trial. We quantified total oxygen consumption costs (2024 international dollars [int$]) and associated greenhouse gas emissions (ktCO₂eq) by integrating country-specific electricity grids and oxygen sources with parameters from a life-cycle assessment of medical oxygen. Uncertainty intervals were generated through Monte-Carlo simulation, and Bayesian multivariable regression was applied to identify determinants of cost and emissions. Scenario analyses modelled emission reductions under three progressively stringent decarbonisation targets.
Adopting conservative rather than liberal SpO₂ targets for ventilated ICU patients would reduce global annual expenditures from 180 to 76 million int$ (Δint$104 million) and cut emissions from 884 to 368 ktCO₂eq (Δ516 ktCO₂eq). Oxygen-related costs were lower in countries with higher Gross Domestic Product per capita but higher in those with greater exposure to fine airborne particles (PM_2.5) and higher out-of-pocket health spending. Per-ICU bed greenhouse gas emissions were highest in the Eastern Mediterranean, Central Asia, and upper-middle-income countries. Higher fossil-fuel electricity share and greater hospital-bed density were associated with increased emissions. Cleaner grids would reduce global oxygen-related emissions by 49.4%-91.9%.
Conservative oxygenation strategies reduce oxygen-related costs and emissions. Aligning oxygen stewardship with energy-transition policies offers a high-impact pathway to reduce the carbon footprint of critical care while strengthening resilience and equity in oxygen access.

PMID:
42386438
Bibliographic data and abstract were imported from PubMed on 02 Jul 2026.

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