The present article underscored the indispensable significance of end-tidal carbon dioxide (ETCO2) monitoring in anesthesia and critical care, offering critical insights into both ventilation and metabolism dynamics. The meticulous management of tidal volume, respiratory rate, and inspired oxygen levels during anesthesia plays a pivotal role in maintaining optimal arterial oxygen and carbon dioxide concentrations. Effective ventilation is imperative for proper gas exchange within the alveoli and maintaining a stable acid-base balance.

In the context of circulatory physiology during anesthesia, cardiac output, blood pressure, and tissue perfusion hold paramount importance. The present article highlights how anesthesia-induced alterations in vascular tone and cardiac function could influence circulation and tissue oxygenation, impacting parameters like blood pressure, heart rate, and ETCO2. Monitoring these parameters provides essential data for assessing circulatory status, guiding anesthesia management, and averting complications.

ETCO2 monitoring has evolved into a standard practice in anesthesia and critical care settings, offering real-time, non-invasive insights. The present article delved into the extensive clinical applications, challenges, and future directions of ETCO2 monitoring. Encompassing fundamental principles, technological nuances, clinical implications, limitations, and avenues for research, this article advanced the understanding of this monitoring technique and its positive impact on patient care.

The present article also discussed how ETCO2 levels reflect alveolar ventilation, providing critical data for assessing ventilation adequacy, readiness for extubation, and identification of impending respiratory distress. Furthermore, it delved into how ETCO2 levels serve as an indicator of cardiac output and tissue perfusion, guiding management strategies in various shock states and offering prognostic insights during CPR.

Challenges and limitations associated with ETCO2 monitoring were clarified, with emphasis on technical considerations, patient populations with specific challenges, and potential interpretation pitfalls. The article outlines the exciting future directions of ETCO2 monitoring, encompassing wearable technology, remote monitoring capabilities, artificial intelligence integration, and potential applications beyond traditional realms.

Received 8 November 2023 | Revised 27 February 2024 | Accepted 11 March 2024

DOI: 10.35755/jmedassocthai.2024.4.13968