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

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

Keywords ETCO2, Pediatrics, Critical care, Procedural sedation, Oximetry

Abstract
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.
Keywords ETCO2, Pediatrics, Critical care, Procedural sedation, Oximetry

Shree Rath1 , Mohammed Alsabri2,3* , Abdelrahman M. Tawfik4

, Eman Makky4

, Muhammad Azan Shahid5
,

Ebraheem A. Ebraheem6

, Alaa Zayed7

and Israa Magdy Ata8

https://doi.org/10.1186/s12245-025-01110-z

2026

peri irawan

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