Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.jns.2020.117078
Title: Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak
Authors: Bharatendu, Chandra 
Ong, Jonathan JY
Goh, Yihui
Tan, Benjamin YQ
Chan, Amanda CY 
Tang, Jonathan ZY
Leow, Aloysius S
Chin, Amanda
Sooi, Kenneth WX
Tan, Yi Lin
Hong, Chiew S
Chin, Benjamin Z
Ng, Elizabeth
Foong, Theng Wai
Teoh, Hock Luen 
Ong, Shi Ting
Lee, Pyng 
Khoo, Deborah
Tsivgoulis, Georgios
Alexandrov, Andrei
Sharma, Vijay K 
Keywords: Science & Technology
Life Sciences & Biomedicine
Clinical Neurology
Neurosciences
Neurosciences & Neurology
Transcranial Doppler (TCD)
Personal protection equipment (PPE)
Powered air-purifying respirator (PAPR)
Carbon dioxide (CO2)
Headache
Healthcare workers
Face-mask
N95
Respirator
Cerebral hemodynamics
Coronavirus disease
COVID-19
AUTOREGULATION
PRESSURE
VELOCITY
FLOW
Issue Date: 2020
Publisher: ELSEVIER
Citation: Bharatendu, Chandra, Ong, Jonathan JY, Goh, Yihui, Tan, Benjamin YQ, Chan, Amanda CY, Tang, Jonathan ZY, Leow, Aloysius S, Chin, Amanda, Sooi, Kenneth WX, Tan, Yi Lin, Hong, Chiew S, Chin, Benjamin Z, Ng, Elizabeth, Foong, Theng Wai, Teoh, Hock Luen, Ong, Shi Ting, Lee, Pyng, Khoo, Deborah, Tsivgoulis, Georgios, Alexandrov, Andrei, Sharma, Vijay K (2020). Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak. JOURNAL OF THE NEUROLOGICAL SCIENCES 417. ScholarBank@NUS Repository. https://doi.org/10.1016/j.jns.2020.117078
Abstract: 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.
Source Title: JOURNAL OF THE NEUROLOGICAL SCIENCES
URI: https://scholarbank.nus.edu.sg/handle/10635/192302
ISSN: 0022510X
18785883
DOI: 10.1016/j.jns.2020.117078
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