Forbes McGain's research while affiliated with Australian And New Zealand Intensive Care Society and other places

Publications (122)

Article
Background and Aim COVID-19 can be transmitted through aerosolised respiratory particles. The degree to which exercise enhances aerosol production has not been previously assessed. We aimed to quantify the size and concentration of aerosol particles and evaluate the impact of physical distance and surgical mask wearing during high intensity exercis...
Article
Importance Whether selective decontamination of the digestive tract (SDD) reduces mortality in critically ill patients remains uncertain. Objective To determine whether SDD reduces in-hospital mortality in critically ill adults. Design, Setting, and Participants A cluster, crossover, randomized clinical trial that recruited 5982 mechanically vent...
Article
INTRODUCTION: Violence in the intensive care unit (ICU) is poorly characterised and its incidence is largely extrapolated from studies in the emergency department. Policy requirements vary between jurisdictions and have not been formally evaluated. METHODS: A multisite, single-time point observational study was conducted across Australasian ICUs wh...
Preprint
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Background Clinical activity accounts for 70–80% of the carbon footprint of healthcare. A critical component of reducing emissions is shifting clinical behaviour towards reducing, avoiding, or replacing carbon-intensive healthcare. The objective of this systematic review was to find, map and assess behaviour change interventions that have been impl...
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Background Timing of initiation of kidney-replacement therapy (KRT) in critically ill patients remains controversial. The Standard versus Accelerated Initiation of Renal-Replacement Therapy in Acute Kidney Injury (STARRT-AKI) trial compared two strategies of KRT initiation (accelerated versus standard) in critically ill patients with acute kidney i...
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Objective To undertake an assessment of the health, financial and environmental impacts of a well-recognised example of low-value care; inappropriate vitamin D testing. Design Combination of systematic literature search, analysis of routinely collected healthcare data and environmental analysis. Setting Australian healthcare system. Participants...
Preprint
Background Healthcare workers treating patients with SARS-CoV-2 are at risk of infection from patient-emitted virus-laden aerosols. We quantified the reduction of airborne infectious virus in a simulated hospital room when a ventilated patient isolation (McMonty) hood was in use. Methods We nebulised 10 ⁹ plaque forming units (PFU) of bacteriophag...
Article
In this era of 'Choosing Wisely,' we present a four-step action plan to reduce unnecessary pathology testing and the associated patient harm (blood loss through repeated phlebotomy), economic cost and environmental impact. The authors are experts from the CODA group; a medical education and health-promotion charity that aims to build on the Choosin...
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Background Pathology testing and diagnostic imaging together contribute 9% of healthcare's carbon footprint. Whilst the carbon footprint of pathology testing has been undertaken, to date, the carbon footprint of the four most common imaging modalities is unclear. Methods We performed a prospective life cycle assessment at two Australian university...
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Climate change is a real and accelerating existential danger. Urgent action is required to halt its progression, and everyone can contribute. Pollution mitigation represents an important opportunity for much needed leadership from the health community, addressing a threat that will directly and seriously impact the health and well‐being of current...
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By providing a means of separating the airborne emissions of patients from the air breathed by healthcare workers (HCWs), vented individual patient (VIP) hoods, a form of local exhaust ventilation (LEV), offer a new approach to reduce hospital-acquired infection (HAI). Results from recent studies have demonstrated that, for typical patient-emitted...
Article
Background Internationally, diabetes mellitus is recognized as a risk factor for severe COVID-19. The relationship between diabetes mellitus and severe COVID-19 has not been reported in the Australian population. Objectives To determine the prevalence of, and outcomes for patients with diabetes admitted to Australian intensive care units (ICUs) wi...
Article
Importance: The efficacy of antiplatelet therapy in critically ill patients with COVID-19 is uncertain. Objective: To determine whether antiplatelet therapy improves outcomes for critically ill adults with COVID-19. Design, setting, and participants: In an ongoing adaptive platform trial (REMAP-CAP) testing multiple interventions within multip...
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In this cross-sectional survey, we assessed knowledge, attitudes and behaviors regarding operating room air-change rates, climate change, and coronavirus disease 2019 (COVID-19) pandemic implications. Climate change and healthcare pollution were considered problematic. Respondents checked air exchange rates for COVID-19 and ∼25% increased them. Res...
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Objectives Economic evaluations of intensive care unit (ICU) interventions have specific considerations, including how to cost ICU stays and accurately measure quality of life in survivors. The aim of this article was to develop best practice recommendations for economic evaluations alongside future ICU randomised controlled trials (RCTs). Review...
Article
Editor - Small changes in practice, when implemented throughout healthcare systems around the world, can have sizable positive impacts on the environment and on health- care costs. It is important for the medical profession to review legacy practices and reconsider interventions with no or low benefit to patients ...
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The Earth's mean surface temperature is already approximately 1.1°C higher than pre-industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convene...
Chapter
This chapter focuses on the consequences to human health from climate change. We argue that the prospects for global human health are more ominous than most informed activists for global health realise. Unsurprisingly, risks to human health increase with the severity of climate change. After reviewing the history of the concerns about climate chang...
Article
Background As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney to reduce non-urgent pathology testing to two days per week and on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impac...
Article
Editor - Nitrous oxide (N2O) is commonly used in some parts of the world for inhalation induction of anaesthesia, labour analgesia, and as an anaesthetic adjuvant. In recent years, there has been a reappraisal of anaesthetic N2O use, partly because of awareness of its environmental impact, coupled with the increasing use of remifentanil which provi...
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Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol‐generating procedure. This designation is based on one epidemiological study suggesting an association between facemask ventilation and transmission during the SARS‐CoV‐1 outbreak in 2003. There is no direct evidence to indicate wh...
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We are in a health emergency precipitated by climate change.¹ As well as physical health threats, climate change and its effects are adversely affecting Australians’ mental health,² and worsening the health inequities suffered by vulnerable populations. In response, the Australian health care community must both adapt to increased demand and to det...
Article
Importance: The evidence for benefit of convalescent plasma for critically ill patients with COVID-19 is inconclusive. Objective: To determine whether convalescent plasma would improve outcomes for critically ill adults with COVID-19. Design, setting, and participants: The ongoing Randomized, Embedded, Multifactorial, Adaptive Platform Trial f...
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Full-text available
The Earth’s mean surface temperature is already approximately 1.1°C higher than pre‐industrial levels. Exceeding a mean 1.5°C rise by 2050 will make global adaptation to the consequences of climate change less possible. To protect public health, anaesthesia providers need to reduce the contribution their practice makes to global warming. We convene...
Article
Background Health care itself contributes to climate change. Anesthesia is a “carbon hotspot,” yet few data exist to compare anesthetic choices. The authors examined the carbon dioxide equivalent emissions associated with general anesthesia, spinal anesthesia, and combined (general and spinal anesthesia) during a total knee replacement. Methods A...
Article
Structured Summary Background While the range of possible transmission pathways of SARS-CoV-2 in various settings has been thoroughly investigated, recently most authorities acknowledged the role of aerosol spread in the transmission of the virus especially in indoor environments where the ventilation is poor. Engineering controls are needed to mi...
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Purpose There is increasing interest within the healthcare sector about the environmental impacts associated with the provision of health services, with the sector being responsible for approximately 4.4% of global greenhouse gas emissions. The aim of this study is to develop an LCA of six commonly used pathology tests in hospitals in Australia, as...
Preprint
Full-text available
Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol generating procedure. This designation is based on a single epidemiological study suggesting an association between facemask ventilation and transmission from the SARS 2003 outbreak. There is no direct evidence to indicate whether...
Article
Full-text available
PurposeTo study the efficacy of lopinavir-ritonavir and hydroxychloroquine in critically ill patients with coronavirus disease 2019 (COVID-19).Methods Critically ill adults with COVID-19 were randomized to receive lopinavir-ritonavir, hydroxychloroquine, combination therapy of lopinavir-ritonavir and hydroxychloroquine or no antiviral therapy (cont...
Article
Editor - We read with interest last year’s article by Zhong and colleagues1 on the environmental and economic impact of using increased fresh gas flow (FGF) to reduce carbon dioxide (CO2) absorbent consumption in the absence of inhalation anaesthetics, and the subsequent correspondence regarding the article, particularly calls to conserve O2 during...
Article
Objective To study the airflow, transmission and clearance of aerosols in the clinical spaces of a hospital ward that had been used to care for patients with COVID-19, and to examine the impact of portable air cleaners on aerosol clearance. Design Observational study. Setting A single ward of a tertiary public hospital in Melbourne Australia. In...
Article
Background Healthcare workers have frequently become infected with SARS-CoV-2 whilst treating patients with COVID-19. A variety of novel devices have been proposed to reduce COVID-19 cross contamination. Objective (i) To test whether patients and Healthcare workers (HCWs) thought that a novel patient isolation hood was safe and comfortable, and (i...
Preprint
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Objective: To assess the effectiveness of aerosol filtration by portable air cleaning devices with high efficiency particulate air (HEPA) filters used in addition to standard building heating ventilation and air-conditioning (HVAC). Methods: Test rooms, including a hospital single-patient room, were filled with test aerosol to simulate aerosol move...
Preprint
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Objective To study the airflow, transmission and clearance of aerosols in the clinical spaces of a hospital ward that had been used to care for patients with COVID-19, and to examine the impact of portable air cleaners on aerosol clearance. Design Observational study Setting A single ward of a tertiary public hospital in Melbourne Australia Interve...
Preprint
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[Objectives]: Are Australian hospitals moving towards renewable energy sources for their electricity, and aligning energy choices with core business, i.e. protecting and promoting health? [Design]: Cross-sectional analysis of Australian state/territory amalgamated energy data [Setting]: Healthcares carbon footprint is approximately 7% of Australias...
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Background The efficacy of interleukin-6 receptor antagonists in critically ill patients with coronavirus disease 2019 (Covid-19) is unclear. Methods We evaluated tocilizumab and sarilumab in an ongoing international, multifactorial, adaptive platform trial. Adult patients with Covid-19, within 24 hours after starting organ support in the intensiv...
Preprint
Background: Healthcare workers have frequently become infected with SARS-CoV-2 whilst treating patients with COVID-19. A variety of novel devices have been proposed to reduce COVID-19 cross contamination. Objective: To test whether a novel patient isolation hood was safe and comfortable, and could potentially reduce HCW COVID-19 infections. Methods...
Article
Approximately 95% of the anesthetic gas administered to a patient is exhaled and ultimately released into the atmosphere. Most anesthetic gases have high global warming potential and so this approach adds significantly to the global greenhouse gas footprint. In this work, we develop a feasible means to capture such an anesthetic gas (sevoflurane) b...
Article
Background Approaches to routine diagnostic testing in the intensive care unit include time-scheduled testing and targeted testing. Blood tests and chest radiographs requested on a routine, time-scheduled basis may reduce the risk of missing important findings. Targeted testing, considering individual patient needs, may reduce unnecessary testing,...
Article
Objective Identify the views of healthcare leaders towards public healthcare's carbon footprint; the importance or not of healthcare energy supply and sources and; the perceived key barriers for Victorian health care to show leadership on renewable energy sources and supply.Methods Self-administered questionnaire (10 Likert scale, two open-ended qu...
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As understanding grows of the scale of health care's environmental impacts, so too does interest in measuring and reporting on sustainability as a facet of health care system performance. This article examines important lessons from health care's long experience with performance and quality measurement and reporting that can be applied to the creat...
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A circular economy involves maintaining manufactured products in circulation, distributing resource and environmental costs over time and with repeated use. In a linear supply chain, manufactured products are used once and discarded. In high-income nations, health care systems increasingly rely on linear supply chains composed of single-use disposa...
Article
Significant concern exists regarding the risk of transmission of severe acute respiratory syndrome coronavirus 2 (SARSCov-2) to health care workers during aerosol generating procedures.The risk of viral transmission to health care workers during tracheostomy insertion is unknown.
Article
Objective: To quantify aerosol generation from respiratory interventions and the effectiveness of their removal by a personal ventilation hood. Design and setting: Determination of the aerosol particle generation (in a single, healthy volunteer in a clean room) associated with breathing, speaking, wet coughing, oxygen (O2) 15 L/min via face mask...
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The detrimental health effects of climate change continue to increase. Although health systems respond to this disease burden, healthcare itself pollutes the atmosphere, land, and waterways. We surveyed the ‘state of the art’ environmental sustainability research within anaesthesia and critical care, addressing why it matters, what is known, and id...
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Is there scope for anaesthesia to turn a green corner?
Article
An investigation of the adsorption properties of two structurally related, 3D coordination polymers of composition Zn(2-Mehba) and Zn(2,6-Me2hba) (2-Mehba = the dianion of 2-methyl-4-hydroxybenzoic acid and 2,6-Me2hba = the dianion of 2,6-dimethyl-4-hydroxybenzoic acid) is presented. A common feature of these structures are parallel channels that a...
Article
Objective: To quantify aerosol generation from respiratory interventions and the effectiveness of their removal by a personal ventilation hood. Design and setting: Determination of the aerosol particle generation (in a single, healthy volunteer in a clean room) associated with breathing, speaking, wet coughing, oxygen (O2) 15 L/min via face mask...
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Objectives To estimate the carbon footprint of five common hospital pathology tests: full blood examination; urea and electrolyte levels; coagulation profile; C‐reactive protein concentration; and arterial blood gases. Design, setting Prospective life cycle assessment of five pathology tests in two university‐affiliated health services in Melbourn...
Article
IMPORTANCE It is unclear whether vitamin C, hydrocortisone, and thiamine are more effective than hydrocortisone alone in expediting resolution of septic shock. OBJECTIVE To determine whether the combination of vitamin C, hydrocortisone, and thiamine, compared with hydrocortisone alone, improves the duration of time alive and free of vasopressor adm...
Article
Healthcare’s environmental sustainability is increasingly an area of research and advocacy focus. The Australian and New Zealand College of Anaesthetists (ANZCA) has produced a professional document, PS64, Statement on Environmental Sustainability in Anaesthesia and Pain Medicine Practice, and a background paper, PS64 BP. The purpose of the stateme...
Article
Strategies to reduce the adverse environmental costs of anaesthesia include choice of agent and fresh gas flows. The current preferences of Australian and New Zealand anaesthetists are unknown. We conducted a survey of Australian and New Zealand anaesthetists to determine the use of volatiles, nitrous oxide and intravenous anaesthesia, lowest fresh...
Article
Background: Although propofol is widely used for sedation in intensive care units around Australia, evaluation of bedside nursing practices of the administration of propofol have been limited. We investigated whether there was a discrepancy between the amount of propofol delivered by the infusion pump and that recorded electronically and consequen...
Article
Objective: To investigate the environmental precipitants, treatment and outcome of critically ill patients affected by the largest and most lethal reported epidemic of thunderstorm asthma. Design, setting and participants: Retrospective multicentre observational study. Meteorological, airborne particulate and pollen data, and a case series of 35...
Article
Objective: To use life cycle assessment to determine the environmental footprint of the care of patients with septic shock in the intensive care unit (ICU). Design, setting and participants: Prospective, observational life cycle assessment examining the use of energy for heating, ventilation and air conditioning; lighting; machines; and all cons...
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Background: A multidisciplinary collaboration investigated the world's largest, most catastrophic epidemic thunderstorm asthma event that took place in Melbourne, Australia, on Nov 21, 2016, to inform mechanisms and preventive strategies. Methods: Meteorological and airborne pollen data, satellite-derived vegetation index, ambulance callouts, emerg...
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Background: The setting of tidal volume (VT) during controlled mechanical ventilation (CMV) in critically ill patients without acute respiratory distress syndrome (ARDS) is likely important but currently unknown. We aimed to describe current CMV settings in intensive care units (ICUs) across Victoria. Methods: We performed a multicentre, prospec...
Article
Objective: To obtain an accurate estimate of smoking prevalence and smoking cessation support practices, including nicotine replacement therapy (NRT), in Australian and New Zealand intensive care units (ICUs). Design, setting and participants: Cross-sectional, observational study using data obtained from adult ICUs participating in the Australia...
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Background Carbon footprints stemming from health care have been found to be variable, from 3% of the total national CO2 equivalent (CO2e) emissions in England to 10% of the national CO2e emissions in the USA. We aimed to measure the carbon footprint of Australia's health-care system. Methods We did an observational economic input–output lifecycle...
Article
We sought to estimate the proportion of patients admitted to a metropolitan intensive care unit (ICU) who were current smokers, and the relationships between ICU survivors who smoked and smoking cessation and/or reduction six months post-ICU discharge. We conducted a prospective cohort study at a metropolitan level III ICU in Melbourne, Victoria. O...
Article
Background.: An innovative approach to choosing hospital equipment is to consider the environmental costs in addition to other costs and benefits. Methods.: We used life cycle assessment to model the environmental and financial costs of different scenarios of replacing reusable anaesthetic equipment with single-use variants. The primary environm...
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Objective To examine the environmental life cycle from poppy farming through to production of 100 mg in 100 mL of intravenous morphine (standard infusion bag). Design ‘Cradle-to-grave’ process-based life cycle assessment (observational). Settings Australian opium poppy farms, and facilities for pelletising, manufacturing morphine, and sterilising...
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Objective The aim of the present study was to quantify hospital steam steriliser resource consumption to provide baseline environmental data and identify possible efficiency gains. We sought to find the amount of steriliser electricity and water used for active cycles and for idling (standby), and the relationship between the electricity and water...
Article
Objectives: Steam sterilization in hospitals is an energy and water intensive process. Our aim was to identify opportunities to improve electricity and water use. The objectives were to find: the time sterilizers spent active, idle and off; the variability in sterilizer use with the time of day and day of the week; and opportunities to switch off...