Green intensive care: reimplementing what LMICs have long practised

The growing recognition of the environmental impact of health care has led to increased efforts to develop sustainable practices.1 Hospitals are major contributors to greenhouse gas emissions and pollution, with intensive care units (ICUs) often generating the most waste. This issue has driven the rise of the concept of green ICUs in high-income countries (HICs);2 initiatives to create green ICUs are focusing on incorporation of advanced technologies, reduction of medical and electronic waste, and optimisation of resource use. Ironically, low-income and middle-income countries (LMICs) have long embraced frugality and sustainability in health care and critical care—out of necessity, not choice. These practices are now being rebranded by HICs under the banner of green ICUs, including many resource-conscious approaches that have been integral to LMIC ICUs for decades. Here, we highlight examples of sustainable ICU and health-care practices in LMICs, challenging the prevailing narrative and advocating for a more inclusive approach to sustainable critical care.