Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak
Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak
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DOI：
10.1016/j.jns.2020.117078
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发表时间：
2020-10-15
影响因子：
4.4
通讯作者：
Sharma, Vijay K.
中科院分区：
文献类型：
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作者：
Bharatendu, Chandra;Ong, Jonathan J. Y.;Sharma, Vijay K.
背景和目的：COVID-19大流行导致卫生保健工作者使用个人防护装备（PPE）的人数空前增加。PPE的使用使大多数使用者感到头痛。我们评估了使用PPE的医护人员脑血流动力学的变化。方法：以三级医疗中心一线卫生工作者为研究对象。记录人口统计、合并症和血压。采用2 mhz探头经颅多普勒（TCD）监测大脑中动脉。分别在基线、佩戴N95口罩后和佩戴动力空气净化呼吸器（PAPR）后记录平均流速（MFV）和脉搏指数（PI）。除N95呼吸面罩外，还记录了佩戴PAPR的参与者的潮末二氧化碳（ET-CO2）压力。结果：共纳入154名医护人员（平均年龄29 +/- 12岁，67%为女性）。偏头痛是最常见的合发性疾病，有38人（25%），123人（80%）因N95口罩而出现从头头痛。佩戴N95口罩导致MFV升高（4.4 +/- 10.4 cm/s, p < 0.001）， PI降低（0.13 +/- 0.12,p < 0.001）， ET-CO2升高3.1 +/- 1.2 mmHg （p < 0.001）。24名（16%）同时佩戴PAPR和N95口罩的参与者TCD监测显示PI正常化，并伴有5分钟内ET-CO2值正常化。与单独使用N95口罩相比，N95口罩与PAPR联合使用更舒适。结论：使用N95口罩可显著改变脑血流动力学。但是，使用额外的PAPR可以减轻这些影响。我们建议在医院病房长时间工作的医护人员使用PAPR和N95口罩。
Background and aim: COVID-19 pandemic has resulted in an unprecedented increased usage of Personal protective equipment (PPE) by healthcare-workers. PPE usage causes headache in majority of users. We evaluated changes in cerebral hemodynamics among healthcare-workers using PPE.Methods: Frontline healthcare-workers donning PPE at our tertiary center were included. Demographics, co-morbidities and blood-pressure were recorded. Transcranial Doppler (TCD) monitoring of middle cerebral artery was performed with 2-MHz probe. Mean flow velocity (MFV) and pulsatility index (PI) were recorded at baseline, after donning N95 respirator-mask, and after donning powered air-purifying respirator (PAPR), when indicated. End-tidal carbon-dioxide (ET-CO2) pressure was recorded for participants donning PAPR in addition to the N95 respirator-mask.Results: A total of 154 healthcare-workers (mean age 29 +/- 12 years, 67% women) were included. Migraine was the commonest co-morbidity in 38 (25%) individuals while 123 (80%) developed de-novo headache due to N95 mask. Donning of N95 respirator-mask resulted in significant increase in MFV (4.4 +/- 10.4 cm/s, p < 0.001) and decrease in PI (0.13 +/- 0.12; p < 0.001) while ET-CO2 increased by 3.1 +/- 1.2 mmHg (p < 0.001). TCD monitoring in 24 (16%) participants donning PAPR and N95 respirator mask together showed normalization of PI, accompanied by normalization of ET-CO2 values within 5-min. Combined use of N95 respirator-mask and PAPR was more comfortable as compared to N95 respirator-mask alone.Conclusion: Use of N95 respirator-mask results in significant alterations in cerebral hemodynamics. However, these effects are mitigated by the use of additional PAPR. We recommend the use of PAPR together with the N95 mask for healthcare-workers doing longer duties in the hospital wards.