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.

中文翻译：

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电动空气净化呼吸器 (PAPR) 在 COVID-19 爆发期间恢复了 N95 面罩引起的医护人员脑血流动力学改变 PPE 相关的脑血流动力学变化

摘要背景和目标 COVID-19 大流行导致医护人员对个人防护设备 (PPE) 的使用空前增加。PPE 的使用让大多数用户感到头疼。我们使用 PPE 评估了医护人员脑血流动力学的变化。方法包括在我们的三级中心穿戴 PPE 的一线医护人员。记录人口统计学、合并症和血压。大脑中动脉的经颅多普勒 (TCD) 监测是用 2-MHz 探头进行的。平均流速 (MFV) 和脉动指数 (PI) 在基线、戴上 N95 呼吸器面罩后和戴上电动空气净化呼吸器 (PAPR) 后（如有需要）记录。除了 N95 呼吸器面罩外，还记录了佩戴 PAPR 的参与者的呼气末二氧化碳 (ET-CO2) 压力。结果 总共包括 154 名医护人员（平均年龄 29 ± 12 岁，67% 为女性）。偏头痛是 38 (25%) 个人中最常见的合并症，而 123 (80%) 人因 N95 面罩而出现新发头痛。佩戴 N95 口罩导致 MFV 显着增加 (4.4 ± 10.4 cm/s, p < 0.001) 和 PI 降低 (0.13 ± 0.12; p < 0.001) 而 ET-CO2 增加 3.1 ± 1.2 mmHg (p < 0.001）。24 名（16%）同时佩戴 PAPR 和 N95 口罩的参与者的 TCD 监测显示 PI 正常化，同时 5 分钟内 ET-CO2 值也正常化。与单独使用 N95 呼吸器面罩相比，结合使用 N95 呼吸器面罩和 PAPR 更舒适。结论 使用 N95 呼吸面罩会显着改变脑血流动力学。然而，使用额外的 PAPR 可以减轻这些影响。对于在医院病房中执行较长时间的医护人员，我们建议将 PAPR 与 N95 面罩一起使用。