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Bharatendu C, Ong JJY, Goh Y, Tan BYQ, Chan ACY, Tang JZY, Leow AS, Chin A, Sooi KWX, Tan YL, Hong CS, Chin BZ, Ng E, Foong TW, Teoh HL, Ong ST, Lee P, Khoo D, Tsivgoulis G, Alexandrov AV, Sharma VK. Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak. J Neurol Sci 2020; 417:117078. [PMID: 32768718 PMCID: PMC7398036 DOI: 10.1016/j.jns.2020.117078] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/10/2020] [Accepted: 07/30/2020] [Indexed: 12/02/2022]
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. Most N95 mask users develop de novo headache or worsening of pre-existing headache. End-tidal carbon dioxide levels increase while donning N95 respirator mask. Significant cerebral hemodynamic changes occur during donning of N95 mask. Powered air-purifying respirator restores N95 mask induced cerebral hemodynamic changes.
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Affiliation(s)
- Chandra Bharatendu
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amanda C Y Chan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Jonathan Z Y Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Emergency Medicine, National University Hospital, Singapore
| | - Aloysius S Leow
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Amanda Chin
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Kenneth W X Sooi
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Yi Lin Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Chiew S Hong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore
| | - Benjamin Z Chin
- Department of Anesthesia, National University Hospital, Singapore
| | - Elizabeth Ng
- Department of Anesthesia, National University Hospital, Singapore
| | - Theng Wai Foong
- Department of Anesthesia, National University Hospital, Singapore
| | - Hock Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Shi Ting Ong
- Department of Emergency Medicine, National University Hospital, Singapore
| | - Pyng Lee
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, Singapore
| | - Deborah Khoo
- Department of Anesthesia, National University Hospital, Singapore
| | - Georgios Tsivgoulis
- Second Department of Neurology, National and Kapodistrian University of Athens, School of Medicine, "Attikon" University Hospital, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Andrei V Alexandrov
- Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN, United States
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore; Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Ong JJY, Bharatendu C, Goh Y, Tang JZY, Sooi KWX, Tan YL, Tan BYQ, Teoh HL, Ong ST, Allen DM, Sharma VK. Headaches Associated With Personal Protective Equipment - A Cross-Sectional Study Among Frontline Healthcare Workers During COVID-19. Headache 2020; 60:864-877. [PMID: 32232837 DOI: 10.1111/head.13811] [Citation(s) in RCA: 247] [Impact Index Per Article: 61.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/29/2020] [Accepted: 03/29/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is an emerging infectious disease of pandemic proportions. Healthcare workers in Singapore working in high-risk areas were mandated to wear personal protective equipment (PPE) such as N95 face mask and protective eyewear while attending to patients. OBJECTIVES We sought to determine the risk factors associated with the development of de novo PPE-associated headaches as well as the perceived impact of these headaches on their personal health and work performance. The impact of COVID-19 on pre-existing headache disorders was also investigated. METHODS This is a cross-sectional study among healthcare workers at our tertiary institution who were working in high-risk hospital areas during COVID-19. All respondents completed a self-administered questionnaire. RESULTS A total of 158 healthcare workers participated in the study. Majority [126/158 (77.8%)] were aged 21-35 years. Participants included nurses [102/158 (64.6%)], doctors [51/158 (32.3%)], and paramedical staff [5/158 (3.2%)]. Pre-existing primary headache diagnosis was present in about a third [46/158 (29.1%)] of respondents. Those based at the emergency department had higher average daily duration of combined PPE exposure compared to those working in isolation wards [7.0 (SD 2.2) vs 5.2 (SD 2.4) hours, P < .0001] or medical ICU [7.0 (SD 2.2) vs 2.2 (SD 0.41) hours, P < .0001]. Out of 158 respondents, 128 (81.0%) respondents developed de novo PPE-associated headaches. A pre-existing primary headache diagnosis (OR = 4.20, 95% CI 1.48-15.40; P = .030) and combined PPE usage for >4 hours per day (OR 3.91, 95% CI 1.35-11.31; P = .012) were independently associated with de novo PPE-associated headaches. Since COVID-19 outbreak, 42/46 (91.3%) of respondents with pre-existing headache diagnosis either "agreed" or "strongly agreed" that the increased PPE usage had affected the control of their background headaches, which affected their level of work performance. CONCLUSION Most healthcare workers develop de novo PPE-associated headaches or exacerbation of their pre-existing headache disorders.
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Affiliation(s)
- Jonathan J Y Ong
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chandra Bharatendu
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yihui Goh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Jonathan Z Y Tang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Emergency Medicine, National University Hospital, Singapore, Singapore
| | - Kenneth W X Sooi
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Yi Lin Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Benjamin Y Q Tan
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hock-Luen Teoh
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shi T Ong
- Department of Emergency Medicine, National University Hospital, Singapore, Singapore
| | - David M Allen
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Division of Infectious Diseases, Department of Medicine, National University Hospital, Singapore, Singapore
| | - Vijay K Sharma
- Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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