CHAPTER 9 END-TIDAL CO₂ IN SEDATION

Does End-tidal Carbon Dioxide Monitoring Detect Respiratory Events Prior to Current Sedation Monitoring Practices?

Burton JH, Harrah JD, Germann CA, et al. Acad Emerg Med. 2006;13(5):500–504

BACKGROUND

End-tidal carbon dioxide (ETCO₂) monitoring is the standard of care in the operating room for monitoring of ventilation, and is the fastest known indicator for apnea, respiratory depression, and airway compromise. Pulse oximetry, the standard of care in the ED prior to this study, is known to have a 2- to 3-minute delay in detecting hypoxemia. Procedural sedation and analgesia (PSA) in the ED can lead to airway compromise and requires continuous monitoring of vital signs. Prior to this study, no specialty organization recommended the routine use of ETCO₂ in the ED.

OBJECTIVES

To determine if ETCO₂ monitoring during PSA in the ED accurately detected acute respiratory events before current methods.

METHODS

Prospective observational study, convenience sample, in 2004.

Participants

Fifty-nine patients undergoing 60 PSA encounters who presented when a study investigator was available were enrolled over a 6-month period.

Interventions

Standard monitoring (continuous SpO₂

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