In Response to: End-tidal CO2 monitoring
Dear Dr. Gelinas,
I am writing to applaud Donnelly Hellings et al. on their article, End-Tidal CO2 Monitoring. I support the authors’ stance that end-tidal CO2 (ETCO2) monitoring, although historically used in anesthetic procedures, has valuable implications for many clinical scenarios (Donnelly Hellings et al., 2024). The use of ETCO2 monitoring as an early indicator for ineffective respiration may avoid hypoxic events leading to intubation. The authors endorse continual CO2 readings as this will provide the practitioner with real-time data that aids in selecting medications, dosages, and treatments (Donnelly Hellings et al., 2024).
Pulse oximetry alone fails to detect ineffective ventilation as this is a multifaceted problem encompassing hypercapnia, hypoventilation, and hypoxemia. Respiratory depression, secondary to opioid administration, initially manifests as hypercapnia, which eventually leads to low pulse oximetry saturation (Khanna et al., 2020). In the critical care setting, practitioners favor spot-checking arterial blood gas samples to assess CO2 retention rather than continuous ETCO2 monitoring (Donnelly Hellings et al., 2024). In both scenarios, continuous ETCO2 would improve response time to patient deterioration and avoid adverse hypoxic events leading to endotracheal intubation.
The combination of both continuous capnography and pulse oximetry ought to be promoted in clinical settings such as emergency departments, infusion clinics, outpatient surgical centers, and post-anesthesia care units. Early detection and intervention of respiratory demise are key to optimal patient care. I want to extend my gratitude to the authors for their exceptional commitment to patient safety.
Sincerely,
Caroline Kahoun, BSN, RN, CCRN. DNP-CRNA Student
Mansfield, OH
