Seeing beyond the numbers: capnography as a vital tool in pediatric emergency care

PURPOSE: End-tidal carbon dioxide (ETCO₂) monitoring is a vital, noninvasive technique for assessing ventilation, circulatory status, and predicting adverse events in pediatric emergency departments (EDs). This review aims to synthesize current evidence, examine barriers, and highlight strategies to optimize ETCO₂ monitoring in pediatric emergency settings. METHODS: A narrative review of the literature was conducted, encompassing epidemiological data, clinical guidelines, expert consensus statements, and recent studies targeting ETCO₂ monitoring in pediatric emergencies. Key topics evaluated include physiological principles, airway management, prognostic value in cardiac arrest, procedural sedation safety, sepsis triage, limitations, and future directions. Data from both high- and low-resource settings were included. RESULTS: ETCO₂ monitoring demonstrates high sensitivity and specificity for confirming endotracheal tube placement and early detection of respiratory compromise-identifying hypoventilation, apnea, and airway obstruction minutes before pulse oximetry. During CPR, persistently low ETCO₂ values correlate with poor outcomes, while sudden increases signal return of spontaneous circulation. In procedural sedation, routine capnography reduces hypoxic episodes and adverse events. In sepsis, ETCO₂ inversely correlates with lactate levels, offering a rapid, non-invasive marker of perfusion, though its reliability diminishes in multisystemic shock. Challenges include equipment limitations, provider training gaps, lack of universal protocols, and cost barriers-especially in low-resource settings. CONCLUSION: ETCO₂ monitoring is an essential tool in pediatric emergency care, enhancing safety and clinical decision-making across multiple scenarios. Addressing implementation barriers through education, standardized protocols, and accessible technology is crucial to ensure widespread adoption and improved outcomes for critically ill children.