Management of Increased End-Tidal CO2 During POEM Procedures

Understanding the Problem

• Normal End-Tidal CO2 (ETCO2) is 35-40 mmHg; values >50 mmHg indicate hypoventilation and potential respiratory compromise requiring immediate intervention, according to the American Society of Anesthesiologists 1, 2

Immediate Ventilatory Management Algorithm

• The American Society of Anesthesiologists recommends targeting ETCO2 of 40-45 mmHg (normocapnia) during the procedure 3

Intraoperative Monitoring Strategy

• Continuous waveform capnography is mandatory to detect trends and ensure endotracheal tube patency, as recommended by the American Society of Anesthesiologists 1
• An absolute change from baseline ETCO2 >10 mmHg is clinically significant and requires immediate assessment, according to the American Society of Anesthesiologists 1, 2

Technical Troubleshooting

• Verify ETT patency, circuit integrity, and sampling line patency to ensure accurate capnography readings, as recommended by the American Society of Anesthesiologists 4