Effects of COVID-19 protective face masks and wearing durations on respiratory haemodynamic physiology and exhaled breath constituents

Abstract

BackgroundWhile assumed to protect against coronavirus transmission, face-masks may have effects on respiratory-haemodynamic parameters. Within this pilot study, we investigated immediate and progressive effects of FFP2 and surgical masks on exhaled breath constituents and physiological attributes in 30 adults at rest.MethodsWe continuously monitored exhaled breath profiles within mask space in older (age: 60–80 years) and young to mid-aged (age: 20–60 years) adults over the period of 15 and 30 min, respectively by high-resolution real-time mass-spectrometry (PTR-ToF-MS). Peripheral oxygen saturation, respiratory- and haemodynamic parameters were measured (non-invasively) simultaneously.ResultsProfound, consistent and significant (p-value≤0.001) changes in SpO2 (Adults>60_FFP2-15 min: 5.8±1.3%↓, Adults>60_surgical-15 min: 3.6±0.9%↓, Adults<60_FFP2-30 min: 1.9±1.0%↓, Adults<60_surgical-30 min: 0.9±0.6%↓) and pET-CO2 (Adults>60_FFP2-15 min: 19.1±8.0%↑, Adults>60_surgical-15 min: 11.6±7.6%↑, Adults<60_FFP2- 30 min: 12.1±4.5%↑, Adults<60_surgical- 30 min: 9.3±4.1%↑) indicate ascending deoxygenation and hypercarbia. Secondary changes (p-value≤0.005) to hemodynamic parameters (e.g. MAP: Adults>60_FFP2-15 min: 9.8±10.4%↑) were found. Exhalation of blood-borne volatile metabolites e.g. aldehydes, hemiterpene, organosulfur, short-chain fatty acids, alcohols, ketone, aromatics, nitrile and monoterpene mirrored behaviour of cardiac output, MAP, SpO2, respiratory rate and pET-CO2. Exhaled humidity (e.g. Adults>60_FFP2-15 min: 7.1±5.8%↑) and exhaled oxygen (e.g. Adults>60_FFP2-15 min: 6.1±10.0%↓) changed significantly (p-value≤0.005) over time.ConclusionsBreathomics allows unique physio-metabolic insights into immediate and transient effects of face-mask wearing. Physiological parameters and breath profiles of endogenous and/or exogenous volatile metabolites indicated putative cross-talk between transient hypoxemia, oxidative stress, hypercarbia, vasoconstriction, altered systemic microbial activity, energy homeostasis, compartmental storage and washout. FFP2 masks affected more pronouncedly than surgical masks. Older adults were more vulnerable to FFP2 mask induced hypercarbia, arterial oxygen decline, blood pressure fluctuations and concomitant physiological and metabolic effects.

Inhaled CO2 Concentration While Wearing Face Masks: A Pilot Study Using Capnography

“…Concerning the risk of hypoxia, several evaluations found that blood oxygen saturation decreases when donning face masks, and even more noticeably when wearing them for long periods or during physical activity. 11 , 22 , 23 , 40 In contrast, the present study was performed at rest and for a short time, during which the recorded levels of CO 2 did not substantially alter blood oxygen saturation, as in similar studies. 13 , 14 , 41 Nevertheless, the exposure to inhaled air CO 2 values higher than 5000 ppm, for long periods, is considered unacceptable for the workers, and is forbidden in several countries, 30 because it frequently causes signs and symptoms such as headache, nausea, drowsiness, rhinitis, and reduced cognitive performance.…”

“…19 Early markers of hypoventilation were observed after the 12-minute walking test among 22 children wearing FFP2 respirators, 20 , 21 after the 6-minute walking test among 100 adults wearing surgical masks, 22 and even at rest in 30 adults and elderly with both types of masks. 23 …”

Real-time metabolic monitoring under exhaustive exercise and evaluation of ventilatory threshold by breathomics: Independent validation of evidence and advances

“…The analysis of volatile organic compounds (VOCs) in human breath offers vast possibilities for the development of non-invasive diagnostic techniques (Miekisch et al, 2004). Breath biomarkers could provide new and unique insights into metabolic (Sukul et al, 2018;2022b), physiological (King et al, 2010b;Sukul et al, 2016Sukul et al, , 2022a or pathophysiological processes (Nakhleh et al, 2017;Trefz et al, 2019;Löser et al, 2020). VOCs are exhaled shortly after their production and may therefore deliver systemic information quickly and noninvasively.…”

Advanced setup for safe breath sampling and patient monitoring under highly infectious conditions in the clinical environment

“…An optimized methodology and/or protocol for reliable and repeatable real-time and offline breathomics under COVID-19 condition as well as additional mandatory safety measures will induce analytical confounders and will increase systematic errors. For instance, we have recently demonstrated immediate and progressive effects of medical face-masks (surgical and FFP2) on exhaled VOCs compositions in healthy adults aged between 20 and 80 years 27 . Therefore, measurements within mask space cannot be attributed for reproducible sampling.…”