Capnography in the pediatric emergency department: clinical applications

Capnography, often referred to by emergency clinicians as end-tidal carbon dioxide monitoring, is a noninvasive method of measuring cardiopulmonary and metabolic parameters that can be utilized in many clinical applications. Growing evidence in the literature in support of the use of capnography has led to increased clinical use of this modality in many pediatric subspecialties. Understanding capnography and the literature supporting its practice will advance its use by emergency clinicians in the pediatric emergency department, promoting improved patient care and safety. This issue reviews the technology and physiology involved in measuring exhaled carbon dioxide and the interpretation of waveforms, and it highlights uses for capnography in pediatric patients in the emergency department. Uses include confirmation of intubation, maintenance of ventilation in intubated and nonintubated children, monitoring of effectiveness of cardiopulmonary resuscitation, and as an adjunct for monitoring of sedated children and children with lower respiratory disease and metabolic derangements.