Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study

Arin Choudhury; Meena Singh; Deepa Kerketta Khurana; Saurav Mitra Mustafi; Usha Ganapathy; Ajay Kumar; Saumya Sharma

doi:10.5005/jp-journals-10071-23671

Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study

Indian J Crit Care Med. 2020 Dec;24(12):1169-1173. doi: 10.5005/jp-journals-10071-23671.

Authors

Arin Choudhury¹, Meena Singh², Deepa Kerketta Khurana¹, Saurav Mitra Mustafi¹, Usha Ganapathy¹, Ajay Kumar¹, Saumya Sharma³

Affiliations

¹ Department of Anesthesia and Intensive Care, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India.
² Department of Anaesthesiology, BPS Medical College for Women, Sonepat, Haryana, India.
³ Department of Ophthalmology, Sharp Sight Group of Eye Hospitals, New Delhi, India.

Abstract

Background: Healthcare workers (HCWs) are at increased risk of exposure to severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Personal protective equipment (PPE) is mandated for HCWs. However, the physiological effects on the HCWs while working in the protective gear remains unexplored. This study aimed to assess the physiological effects of the prolonged use of PPE on HCWs.

Materials and methods: Seventy-five HCWs, aged 18-50 years were enrolled in this prospective, observational, cohort study. The physiological variables [heart rate, oxygen saturation, and perfusion index (PI)] were recorded at the start of duty, 4 hours after wearing N95 filtering facepiece respirator (FFR), pre-donning, and post-doffing. The rating of perceived exertion (RPE) score and modified Borg scale for dyspnea was evaluated. The physiological variables were represented as the mean ± standard deviation. Wilcoxon signed-rank test was used to show any difference in RPE and modified Borg scale for dyspnea. A p value of <0.05 was considered significant.

Results: There is a statistically significant difference in the physiological parameters post-doffing compared with baseline: Heart rate (p < 0.001); oxygen saturation (p < 0.001); PI (p < 0.001). RPE score showed increased discomfort with continuous use of N95 FFR. However, exertion increased only marginally. The major adverse effects noted with PPE use were fogging, headache, tiredness, difficulty in breathing, and mask soakage, with a resultant mean duration of donning to be 3.1 hours.

Conclusion: The use of PPE can result in considerable changes in the physiological variables of healthy HCWs. The side effects may lead to excessive exhaustion and increased tiredness after prolonged shifts in the intensive care unit (ICU) while wearing PPE.

How to cite this article: Choudhury A, Singh M, Khurana DK, Mustafi SM, Ganapathy U, Kumar A, et al. Physiological Effects of N95 FFP and PPE in Healthcare Workers in COVID Intensive Care Unit: A Prospective Cohort Study. Indian J Crit Care Med 2020;24(12):1169-1173.

Keywords: COVID-19; Healthcare workers; Heart rate; Intensive care unit; N95 respirators; Oxygen saturation; Perfusion index; Personal protective equipment; Physiological; Stress.