Intravenous-to-enteral drug substitution in the ICU: a single-centre analysis of the potential to reduce the environmental footprint of critical care - Report - MDSpire
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Evaluating the Transition from Intravenous to Enteral Medications in the ICU: A Single-Center Study on Reducing the Environmental Impact of Critical Care

  • By

  • Clémence Marois

  • Maxime Gasperment

  • Adam Celier

  • Ambre Preteux

  • Grégoire Gaucher

  • Léontine Scherer

  • Nicolas Weiss

  • Kevin Bihan

  • Marie Lecronier

  • Amélie Liou

  • September 22, 2026

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Clinical Report: Evaluating the Transition from Intravenous to Enteral Medications in the ICU

Overview

This study identifies intravenous medications in the ICU that have viable enteral alternatives. A total of 63 out of 269 medications were found to have feasible enteral counterparts.

Background

Intravenous medications in the ICU contribute significantly to greenhouse gas emissions due to the use of single-use devices. Transitioning to enteral medications can mitigate these emissions while also reducing risks associated with IV therapy.

Data Highlights

Medication CategoryCount
Ready for IV-to-enteral substitution54
Requires monitoring before substitution9

Key Findings

  • 63 out of 269 intravenous medications had viable enteral alternatives.
  • 54 medications were classified as Ready for IV-to-enteral substitution.
  • 9 medications required monitoring before substitution due to unpredictable absorption.
  • Transitioning 50% of IV administrations to enteral could reduce emissions by 12.7 tCO8 annually.
  • The five most frequently dispensed eligible drugs accounted for 37.7 tCO8 and 8,206 in costs.
  • Complete substitution could double the projected reductions in emissions and costs.

Clinical Implications

Clinicians should evaluate the appropriateness of IV medications and consider enteral alternatives when feasible.

Conclusion

The study identifies an opportunity for reducing the environmental footprint of critical care through the transition from IV to enteral medications.

Related Resources & Content

  1. Intensive Care Medicine, 2022 -- Addressing Climate Impact in Critical Care
  2. Intensive Care Medicine, 2021 -- Recent Advances in Intensive Care: Focusing on Environmental Sustainability
  3. Intensive Care Medicine, 2025 -- Guidelines for Conducting Environmentally Sustainable Research in Intensive Care Units
  4. IDSA 2026 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections
  5. Intensive Care Medicine — Circular Resource Management in Intensive Care Units: Environmental Impacts and Identification of Key Areas for Improvement
  6. IDSA 2026 Guidance on the Treatment of Antimicrobial Resistant Gram-Negative Infections
  7. Oral switch vs. continued intravenous antibiotic therapy in patients with bacteraemia and sepsis: a systematic review and meta-analysis - PubMed
  8. Environmental and financial impacts of perioperative paracetamol use: a multicentre international life-cycle assessment - ScienceDirect

Original Source(s)

Intravenous-to-enteral drug substitution in the ICU: a single-centre analysis of the potential to reduce the environmental footprint of critical care

  • by Clémence Marois, Maxime Gasperment, Adam Celier, Ambre Preteux, Grégoire Gaucher, Léontine Scherer, Nicolas Weiss, Kevin Bihan, Marie Lecronier, Amélie Liou

  • September 22, 2026

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