Evidence map›Paper›PMID 41998736›Full record

ArticleJournal of anesthesia, analgesia and critical care2026

Attitudes, knowledge, practices, and perceived barriers on sustainability actions among Italian anesthesiologists-intensivists: a nationwide survey.

Raffaele Mandarano, Savino Spadaro, Danila Azzolina, Rita Commissari, Vincenzo Lionetti, Roberta Monzani, Stefano Romagnoli, Massimiliano Sorbello, Alessia Violini, Elena Bignami and 1 more

Abstract read
In one paragraph

Article in Journal of anesthesia, analgesia and critical care, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Raffaele Mandarano *Department of anaesthesia and intensive care units IRCCS, Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy. mandarano.raffaele@live.it.
Savino Spadaro *Department of Translational Medicine, University of Ferrara, Ferrara, Italy.
Danila AzzolinaBiostatistics and Clinical Trial Methodology Unit, Clinical Research Center DEMeTra, Department of Translational Medicine, University of Naples Federico II, Naples, Italy.
Rita CommissariAnesthesia, Intensive Care and Nutritional Science, Azienda Ospedaliero-Universitaria 'Santa Maria', Via Tristano Di Joannuccio, 05100, Terni, Italy.
Vincenzo LionettiTrancriLab, Laboratory of Basic and Applied Medical Research, Interdisciplinary Research Center 'Health Science', Scuola Superiore Sant'Anna, Pisa, Italy.
Roberta MonzaniSurgical Day Hospital, Humanitas Research Hospital IRCCS, Rozzano, Milan, Italy.
Stefano RomagnoliDepartment of anaesthesia and intensive care units IRCCS, Humanitas Research Hospital, via Manzoni 56, 20089, Rozzano, Milan, Italy.
Massimiliano SorbelloDepartment of Anesthesia and Intensive Care, Hospital 'Giovanni Paolo II', ASP Ragusa, Ragusa, Italy.
Alessia VioliniDirector of Palliative Care and Hospice Unit, ASL1, Liguria, Italy.
Elena BignamiAnesthesiology, Intensive Care and Pain Medicine Division, Department of Medicine and Surgery, University of Parma, 43126, Parma, Italy.
Gilda CinnellaDepartment of Anesthesia and Intensive Care, Policlinico Hospital, University Hospital of Foggia, Foggia, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHealthcare systems contribute approximately 4.6% of global carbon emissions, with anesthesia and intensive care representing major sources of environmental impact. Although awareness of sustainable practices is increasing, real-world implementation in these fields remains limited. This study aimed to describe knowledge, attitudes, practices, and perceived barriers toward sustainability among Italian anesthesiologists-intensivists.

methodsA cross-sectional, web-based survey was conducted among members of the Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI) between June and July 2025. The questionnaire assessed demographics, clinical practices, environmental behaviors, and perceived barriers to sustainability. Descriptive statistics and an unsupervised clustering approach (Factor Analysis of Mixed Data followed by hierarchical clustering) were applied to identify distinct respondent profiles.

resultsA total of 459 responses were analyzed. Overall, 83.4% rated environmental sustainability as "very important," and 95.6% supported the adoption of renewable energy in hospitals. Despite this, 93.1% reported routine use of single-use devices, and only 7.4% worked in departments with a designated sustainability officer. Cluster analysis identified two main groups: the Experienced Generation (older, senior specialists) and the Green Generation (younger, early-career clinicians). While both valued sustainability, the Green Generation more frequently implemented eco-friendly practices, including the use of total intravenous anesthesia (71.2% vs. 57.5%), regional anesthesia (74.1% vs. 64.0%), and reusable/recyclable devices (> 80% vs. < 20%). The most frequently reported barriers to sustainability application were lack of training (76.3%), resistance to change (66.4%), and absence of guidelines (54.7%).

conclusionsItalian anesthesiologists-intensivists demonstrate strong environmental awareness but variable implementation of sustainable practices. Strengthening formal education, institutional leadership, and guideline dissemination is essential to promote widespread adoption of sustainable anesthesia and intensive care practices.

Indexed as

AnesthesiaEnvironmental impactGreenIntensive careItalySIAARTISurveySustainability

Identifiers

PMID41998736
PMCPMC13159205

What Socratic holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.