Acute physiologic effects of N95 respirator use on gastroenterologists performing simulated colonoscopy

Khalid, Asif; Romutis, Stephanie; Ibinson, Jonathan; Thomas, Christopher; Myint, Alex; Dueker, Jeffrey; Johnston, Elyse; Kreiss, Christianna; Kingsley, Michael; Skef, Wasseem; Vipperla, Kishore; McGrath, Kevin; Phillips, Anna E.; Das, Rohit; Fasanella, Kenneth E.; Ibinson, James W.

doi:10.1016/j.gie.2021.01.017

Cited by 4 publications

(8 citation statements)

References 26 publications

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“…We believe the difference in experiment duration is the cause for these results. In our previous study 4 , the duration of simulated exams for each stage (e. g. SM, N95FFR) was 60 minutes, while in the current study it is 20 minutes. We selected 20 minutes as the experiment stage duration for this study based on the observation from our prior study 4 that the N95FFR-related increase in depth of breathing occurred immediately.…”

Section: Discussionmentioning

confidence: 69%

“…In our previous study 4 , the duration of simulated exams for each stage (e. g. SM, N95FFR) was 60 minutes, while in the current study it is 20 minutes. We selected 20 minutes as the experiment stage duration for this study based on the observation from our prior study 4 that the N95FFR-related increase in depth of breathing occurred immediately. We anticipate that this alteration in respiratory physiology leads to change in N95FFR user vitals with increasing duration of N95FFR use, i. e. over 20 minutes.…”

Section: Discussionmentioning

confidence: 69%

“…We note that while there was an increase in respiratory effort in gastroenterologists when using an N95FFR compared to an N95FFR plus an END, this did not translate into a change in other physiological parameters e. g. HR. We have previously reported that N95FFR use is associated with statistically significant HR elevation compared to a SM, especially in gastroenterologists reporting multiple symptoms due to N95FFR use 4 . We believe the difference in experiment duration is the cause for these results.…”

Section: Discussionmentioning

confidence: 92%

“…N95FFR are superior to SMs in preventing betacoronavirus infection in HCWs and are recommended while performing gastrointestinal endoscopy during the SARS-CoV-2 pandemic 1 11 . Unfortunately, N95FFR use is associated with impaired nasal airflow, increased breathing resistance and possibly increased levels of inhaled CO 2 , and a shift to anaerobic metabolism resulting in a number of symptoms including respiratory difficulty, headaches, increased irritability, and impaired physical work capacity 2 3 4 5 .…”

Section: Discussionmentioning

confidence: 99%

“…N95 filtering facepiece respirators (FFRs) decrease risk of betacoronavirus infection in health care workers (HCWs) compared to surgical masks (SMs) 1 and are being used in clinical areas like gastrointestinal endoscopy laboratories (gastrointestinal lab) considered high risk for respiratory aerosol generation during the SARS-CoV-2 pandemic. N95FFR users including gastroenterologists suffer a variety of physical and psychological symptoms due to the associated impaired nasal airflow and increased breathing resistance 2 3 4 5 .…”

Section: Introductionmentioning

confidence: 99%

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External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff

et al. 2022

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Background/ study aims: N95 filtering facepiece respirators (FFR) use is associated with physiological changes and symptoms due to impaired nasal airflow and increased breathing resistance. We prospectively studied the effect of using an external nasal dilator (END) in gastroenterology laboratory (GI lab) staff using N95FFR. Participants/ materials and methods: N95FFR qualitative saccharine fit testing was performed on study participants with and without an END. Prospective data collection and comparisons included: 1) survey of perceived symptoms and difficulty of performing one day of GI procedures with N95FFR and one day of GI procedures with END plus N95FFR in random sequence and 2) vitals and respiratory belt plethysmography in ten gastroenterologists performing simulated colonoscopy while wearing a surgical mask (SM), N95FFR plus SM, END plus N95FFR plus SM for 20 minutes each in random sequence and rapid succession. Results: Twenty-nine of 31 participants passed the N95FFR and the END plus N95FFR fit test. Twenty-two participants (12 physicians; 11 males; mean age 44.1 years, range 31-61) performed one day of GI procedures with an N95FFR and one day of GI procedures with an END plus N95FFR. Significantly less difficulty with nasal breathing and severity of symptoms including breathing difficulty, headache, fatigue and frustration occurred while using an END plus N95FFR. Respiratory plethysmography peak to trough measurement showed an increase during the N95FFR stage compared to the END plus N95FFR stage and the SM stage. Conclusions: N95FFR related respiratory changes and symptom development may be mitigated by END use.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff

et al. 2022

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Behind the mask: physiologic effects of facial personal protective equipment during endoscopy

Chisholm

Smith

2021

Gastrointestinal Endoscopy

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Safety implications of mask use: a systematic review and evidence map

Farah,

Abusalih,

Hasan

et al. 2024

BMJ EBM

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BackgroundWidespread use of respiratory protection masks has become a critical component of public health response.ObjectivesThis systematic review synthesises the evidence on the acute physiological, cognitive and psychological impacts associated with different types of masks and provides an evidence map of research gaps.MethodsA comprehensive search from 2000 to 2023 was conducted across multiple databases (MEDLINE, EMBASE, Cochrane databases, Scopus and PubMed). An umbrella systematic overview was conducted for physiological outcomes using existing systematic reviews. We conducted de novo systematic reviews for cognitive and psychological outcomes. Pairs of independent reviewers determined eligibility, extracted data and assessed risk of bias. Certainty at an outcome level was appraised using the Grading of Recommendations Assessment, Development and Evaluation approach.ResultsThe search resulted in 13 370 potential citations, leading to the inclusion of nine systematic reviews for physiological outcomes (87 primary studies) and 10 primary studies for cognitive and psychological outcomes (3815 participants), with the majority of participants being healthy adults. Studies evaluating physiological outcomes demonstrated that various types of masks have little to no significant difference in heart rate (surgical mask (mean difference (MD): 0.96 (−1.01 to 2.93)), N95 mask (MD: 1.63 (−2.79 to 6.05)) and cloth mask (MD: −0.94 (−6.39 to 4.52))) or respiratory rate during rest or exercise (surgical mask (MD: −1.35 (−3.00 to 0.29)), N95 mask (MD: 0.10 (−3.10 to 3.29)) and cloth mask (MD: −2.57 (−6.44 to 1.29)) (low certainty for most outcomes)). Mask use may be associated with very small changes in minute ventilation (surgical mask (MD: −13.9 (−20.30 to −7.53)) and N95 mask (MD: −16.3 (−28.7 to −3.9))), tidal volume (surgical mask (MD: −0.14 (−0.23 to −0.05)) and N95 mask (MD: −0.10 (−0.33 to 0.13))), oxygen saturation (surgical mask (MD: −0.59% (−0.87 to −0.30)), N95 mask (MD: −0.35% (−0.75 to 0.05)) and cloth mask (MD: −0.50% (−1.23; 0.24))), carbon dioxide partial pressure (surgical mask (standardised MD (SMD): 1.17 (0.70 to 1.64)) and N95 mask (SMD: 0.43 (0.08 to 0.79))) and exercise performance (surgical mask (SMD: −0.12 (−0.39 to 0.15)), N95 mask (SMD: −0.42 (−0.76 to −0.08)) and cloth mask (SMD: −0.26 (−0.54 to 0.02)) (low certainty for most outcomes)). Studies evaluating cognitive outcomes showed mixed results. Some studies reported reduced mental workload, and others showed no significant effect or decreased performance. The impact on attention, errors and reaction time was variable. These studies were small and at moderate to high risk of bias. Evidence was insufficient to estimate the effect of mask use on psychological outcomes (claustrophobia, depression and anxiety) as these studies were small, non-longitudinal and at high risk of bias.ConclusionThis evidence map provides a comprehensive insight into the multifaceted impact of respiratory protection mask use, and highlights the limited certainty in the available body of evidence. This evidence map supports the development of future research agenda.

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Acute physiologic effects of N95 respirator use on gastroenterologists performing simulated colonoscopy

Cited by 4 publications

References 26 publications

External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff

External nasal dilator decreases N95 respirator-related respiratory effort and symptoms in gastrointestinal endoscopy unit staff

Behind the mask: physiologic effects of facial personal protective equipment during endoscopy

Safety implications of mask use: a systematic review and evidence map

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