Physiologic effects of surgical masking in children versus adults
Background Surgical masks remain a focal part of the CDC guidelines to decrease COVID-19 transmission. Evidence refuting significant effects of masking on ventilation is mostly limited to small studies, with a paucity of studies on children, and none comparing children to adults. Methods A total of...
| Main Authors: | , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
PeerJ Inc.
2023-06-01
|
| Series: | PeerJ |
| Subjects: | |
| Online Access: | https://peerj.com/articles/15474.pdf |
| _version_ | 1827605803015602176 |
|---|---|
| author | J Patrick Brooks Jill Layman Jessica Willis |
| author_facet | J Patrick Brooks Jill Layman Jessica Willis |
| author_sort | J Patrick Brooks |
| collection | DOAJ |
| description | Background Surgical masks remain a focal part of the CDC guidelines to decrease COVID-19 transmission. Evidence refuting significant effects of masking on ventilation is mostly limited to small studies, with a paucity of studies on children, and none comparing children to adults. Methods A total of 119 subjects were enrolled (71 adults, 49 children) in a prospective interventional study with each subject serving as their own mask-free control. End tidal CO2 (ETCO2), inspired CO2 (ICO2), and respiratory rate were measured by nasal cannula attached to an anesthesia machine D-fend module. Pulse oximetry and heart rate were also followed. After the mask-free period, an ASTM Level 3 disposable surgical mask was donned and 15 min of mask-worn data were collected. Results A steady state was confirmed for ETCO2 and ICO2 over the masked period, and mean ICO2 levels rose significantly (p < 0.001) after masking in all age groups. The increase in ICO2 for the 2- to 7-year-old group of 4.11 mmHg (3.23–4.99), was significantly higher (p < 0.001) than the final ΔICO2 levels for both the 7- to 14-year-old group, 2.45 mmHg (1.79–3.12), and adults, 1.47 mmHg (1.18–1.76). For the pediatric group there was a negative, significant correlation between age and ΔICO2, r = −0.49, p < 0.001. Masking resulted in a statistically significant (p < 0.01) rise in ETCO2 levels of 1.30 mmHg in adults and 1.36 mmHg in children. The final respective ETCO2 levels, 34.35 (33.55–35.15) and 35.07 (34.13–36.01), remained within normal limits. Pulse oximetry, heart rate, and respiratory rate were not significantly affected. Discussion The physiology of mechanical dead space is discussed, including the inverse relationship of subject age vs ICO2. The methodology and results are compared to previously published studies which detracted from the physiologic safety of surgical masking. Conclusions The wearing of a surgical mask results in a statistically significant rise in ICO2 and a smaller rise in ETCO2. Because ETCO2 and other variables remain well within normal limits, these changes are clinically insignificant. |
| first_indexed | 2024-03-09T06:27:40Z |
| format | Article |
| id | doaj.art-339dd049b4e84fe28182629938132b6c |
| institution | Directory Open Access Journal |
| issn | 2167-8359 |
| language | English |
| last_indexed | 2024-03-09T06:27:40Z |
| publishDate | 2023-06-01 |
| publisher | PeerJ Inc. |
| record_format | Article |
| series | PeerJ |
| spelling | doaj.art-339dd049b4e84fe28182629938132b6c2023-12-03T11:15:44ZengPeerJ Inc.PeerJ2167-83592023-06-0111e1547410.7717/peerj.15474Physiologic effects of surgical masking in children versus adultsJ Patrick Brooks0Jill Layman1Jessica Willis2School of Anesthesia, Missouri State University, Springfield, Missouri, United StatesSchool of Anesthesia, Missouri State University, Springfield, Missouri, United StatesRStats Institute, Missouri State University, Springfield, Missouri, USABackground Surgical masks remain a focal part of the CDC guidelines to decrease COVID-19 transmission. Evidence refuting significant effects of masking on ventilation is mostly limited to small studies, with a paucity of studies on children, and none comparing children to adults. Methods A total of 119 subjects were enrolled (71 adults, 49 children) in a prospective interventional study with each subject serving as their own mask-free control. End tidal CO2 (ETCO2), inspired CO2 (ICO2), and respiratory rate were measured by nasal cannula attached to an anesthesia machine D-fend module. Pulse oximetry and heart rate were also followed. After the mask-free period, an ASTM Level 3 disposable surgical mask was donned and 15 min of mask-worn data were collected. Results A steady state was confirmed for ETCO2 and ICO2 over the masked period, and mean ICO2 levels rose significantly (p < 0.001) after masking in all age groups. The increase in ICO2 for the 2- to 7-year-old group of 4.11 mmHg (3.23–4.99), was significantly higher (p < 0.001) than the final ΔICO2 levels for both the 7- to 14-year-old group, 2.45 mmHg (1.79–3.12), and adults, 1.47 mmHg (1.18–1.76). For the pediatric group there was a negative, significant correlation between age and ΔICO2, r = −0.49, p < 0.001. Masking resulted in a statistically significant (p < 0.01) rise in ETCO2 levels of 1.30 mmHg in adults and 1.36 mmHg in children. The final respective ETCO2 levels, 34.35 (33.55–35.15) and 35.07 (34.13–36.01), remained within normal limits. Pulse oximetry, heart rate, and respiratory rate were not significantly affected. Discussion The physiology of mechanical dead space is discussed, including the inverse relationship of subject age vs ICO2. The methodology and results are compared to previously published studies which detracted from the physiologic safety of surgical masking. Conclusions The wearing of a surgical mask results in a statistically significant rise in ICO2 and a smaller rise in ETCO2. Because ETCO2 and other variables remain well within normal limits, these changes are clinically insignificant.https://peerj.com/articles/15474.pdfSurgical masksRespiratory physiologyEnd tidal CO2Inspired CO2Pulse oximetry |
| spellingShingle | J Patrick Brooks Jill Layman Jessica Willis Physiologic effects of surgical masking in children versus adults PeerJ Surgical masks Respiratory physiology End tidal CO2 Inspired CO2 Pulse oximetry |
| title | Physiologic effects of surgical masking in children versus adults |
| title_full | Physiologic effects of surgical masking in children versus adults |
| title_fullStr | Physiologic effects of surgical masking in children versus adults |
| title_full_unstemmed | Physiologic effects of surgical masking in children versus adults |
| title_short | Physiologic effects of surgical masking in children versus adults |
| title_sort | physiologic effects of surgical masking in children versus adults |
| topic | Surgical masks Respiratory physiology End tidal CO2 Inspired CO2 Pulse oximetry |
| url | https://peerj.com/articles/15474.pdf |
| work_keys_str_mv | AT jpatrickbrooks physiologiceffectsofsurgicalmaskinginchildrenversusadults AT jilllayman physiologiceffectsofsurgicalmaskinginchildrenversusadults AT jessicawillis physiologiceffectsofsurgicalmaskinginchildrenversusadults |