In this episode of *Pediatric Critical Care Insights*, Dr. Monica Gray and Dr. Pradip Kamat chat about how capnography, specifically end-tidal CO2 monitoring, is used in the pediatric ICU. They walk through a real-life case of a 9-year-old with respiratory failure from influenza A, showing how ETCO2 monitoring helps confirm endotracheal tube placement, guides ventilation, spots cardiac arrest, and even helps assess the quality of CPR. Along the way, they break down how to interpret capnography waveforms, discuss different types of devices, and explain the key physiological concepts. The episode is packed with practical, bedside tips for intensivists caring for critically ill kids.

Show Highlights:

• Importance of capnography (end-tidal CO2 monitoring) in the pediatric intensive care unit (PICU)
• Clinical case study of a 9-year-old boy with respiratory failure due to influenza A
• Use of capnography for confirming endotracheal tube placement and assessing ventilation status
• Detection of cardiac arrest and guidance for CPR quality through ETCO2 monitoring
• Overview of capnography physics and physiology, including terminology distinctions
• Types of capnography: mainstream vs. sidestream, and their applications in pediatric patients
• Assumptions for accurate ETCO2 approximation of arterial CO2 and conditions affecting this relationship
• Analysis of capnography waveform phases and their clinical significance
• Prognostic value of ETCO2 during cardiac arrest and its correlation with patient outcomes
• Practical applications of ETCO2 monitoring in critical care, focusing on airway, breathing, and circulation management

References:

1. Noninvasive respiratory monitoring and assessment of gas exchange. David F. Butler; Kenneth A. Schenkman. Fuhrman and Zimmerman's Pediatric Critical Care, 43, 483-491.e3
2. Humphreys S, Schibler A, von Ungern-Sternberg BS. Carbon dioxide monitoring in children—A narrative review of physiology, value, and pitfalls in clinical practice. Pediatr Anaesth. 2021;31:839–845. https://doi.org/10.1111/pan.14208
3. Lasa JJ, Dhillon GS, Duff JP, et al. Part 8: Pediatric Advanced Life Support: 2025 American Heart Association and American Academy of Pediatrics Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2026;157(1):e2025074351
4. O'Flaherty. Capnography: principles and practice. London: BMJ Publishing Group; 1994.
5. Aminiahidashti H, Shafiee S, Zamani Kiasari A, Sazgar M. Applications of End-Tidal Carbon Dioxide (ETCO2) Monitoring in Emergency Department; a Narrative Review. Emerg (Tehran). 2018;6(1):e5. Epub 2018 Jan 15. PMID: 29503830; PMCID: PMC5827051.