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.

Study Design

Prospective, observational case series using a convenience sample.

Single-center, 500-bed tertiary hospital emergency department.

Blinded design: Clinical staff were blinded to ETCO₂ readings; a study investigator monitored and recorded data.

Institutional review board-approved with interim safety analyses performed after every 30 patients.