End-tidal CO2 measurement in emergency management. In nonintubated patients as well?

End-tidal CO2 can be measured with chemical indicators or with infrared spectroscopy. Especially with capnography, it is possible to obtain important information about the condition of emergency patients, regardless if they are ventilated or breathing spontaneously. Importantly, this information can influence emergency management and improve safety for emergency patients. In this article, a closer look will be taken of end-expiratory CO2 measurement and deeper insight into current data on the use in nonintubated patients. Review of current literature, clinical trials, standards, guidelines, and recommendations. Current guidelines and recommendations include the use of capnography. Most of these recommendations concern patients treated with an endotracheal tube or supraglottic airway but some include guidance for spontaneously breathing patients. Recommendations of the German Society of Anesthesia and Intensive Care (DGAI) include the use of capnography in spontaneous breathing patients especially in case of interventions that require analgosedation. Today, there are not enough randomized studies to definitively recommend the use of capnography in nonintubated patients. However, published reviews conclude that current guidelines and recommendations should be followed to ensure a high safety standard, until there are enough studies to make further evidence-based decisions.