Capnography is now recognized as an indispensable patient safety monitor. Evidence suggests
that its use improves outcomes in operating rooms, intensive care units, and emergency departments,
as well as in sedation suites, in postanesthesia recovery units, and on general postsurgical
wards. Capnography can accurately and rapidly detect respiratory, circulatory, and metabolic
derangements. In addition to being useful for diagnosing and managing esophageal intubation,
capnography provides crucial information when used for monitoring airway patency and hypoventilation
in patients without instrumented airways. Despite its ubiquitous use in high-income-country
operating rooms, deaths from esophageal intubations continue to occur in these contexts due to
incorrect use or interpretation of capnography. National and international society guidelines on
airway management mandate capnography’s use during intubations across all hospital areas, and
recommend it when ventilation may be impaired, such as during procedural sedation. Nevertheless,
capnography’s use across high-income-country intensive care units, emergency departments, and
postanesthesia recovery units remains inconsistent. While capnography is universally used in
high-income-country operating rooms, it remains largely unavailable to anesthesia providers in
low- and middle-income countries. This lack of access to capnography likely contributes to more
frequent and serious airway events and higher rates of perioperative mortality in low- and middleincome
countries. New capnography equipment, which overcomes cost and context barriers, has
recently been developed. Increasing access to capnography in low- and middle-income countries
must occur to improve patient outcomes and expand universal health care. It is time to extend
capnography’s safety benefits to all patients, everywhere.