0922 Continuous end-tidal CO2 (ETCO2) monitoring: helpful and underutilized

A recent article published in the Journal of Critical Care reports on the results of a survey of paediatric ICUs in the USA in which programme directors were asked a number of questions around use of ETCO2 (also known as capnography) in the management of both ventilated and non-ventilated patients. Most of the 40 respondents indicated that the technology was inexpensive and easy to use, and relied on it to verify endotracheal tube placement and for ventilator management. Around 50% used the technology to monitor responses to CPR. ETCO2 monitoring was also used by some to manage airway obstruction (e.g. asthma), apnoea, brain injury requiring hyperventilation, pulmonary embolism, drug-related hypoventilation, metabolic acidosis (diabetic or related to gastroenteritis), weaning from a ventilator, and patient transport. The equipment can very quickly be connected and set up via endotracheal tube or nasal cannulae, requires no procedural skills, and provides the clinician with continuous monitoring that is non-invasive, accurate and easy to interpret. It is 6 years since critical care bodies updated guidelines for paediatric ICU care, guidelines that included equipment requirements and monitoring of quality of care. Continuous ETCO2 monitoring capability was included in the guidelines as a minimum requirement; perhaps it is time for the technology to be applied more widely.

Read more:
J Critical Care 2009; 24: 227-30
American Society of Anesthesiologists. Standards for Basic Anesthetic Monitoring; 2005
Pediatr Emerg Care 2005; 21: 574-7
Pediatr Diabetes 2006; 7: 196-200