EBQ:End-Tidal CO2 Monitoring

incomplete Journal Club Article

Burton J. et al.. "Does end-tidal carbon dioxide monitoring detect respiratory events prior to current sedation monitoring practices?". Acad Emerg Med. 2006. 13(5):500-4.
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Clinical Question

Can end-tidal carbon dioxide (ETCO₂) monitoring during emergency department procedural sedation and analgesia (PSA) detect acute respiratory events earlier than standard monitoring methods (e.g., SpO₂, clinical observation)?

Conclusion

ETCO₂ monitoring identified the majority of acute respiratory events during PSA, and in 70% of these cases, abnormalities were detected before clinical recognition via SpO₂ or observed hypoventilation. ETCO₂ monitoring offers earlier detection of respiratory compromise than current standard practices.

Major Points

33% of PSA encounters included acute respiratory events.

85% of those with respiratory events had abnormal ETCO₂ findings.

In 70% of events, abnormal ETCO₂ was recorded before observed clinical signs.

Many ETCO₂ abnormalities were not associated with interventions, suggesting possible transient or clinically insignificant episodes.

Use of capnography may enhance detection of early hypoventilation or apnea and improve patient safety during PSA.