Post written by Asif Khalid, MD, from the VA Pittsburgh HealthCare System, and the University of Pittsburgh Medical System, Pittsburgh, Pennsylvania, USA.

Gastroenterologists and GI lab staff are required to use N95 respirators while performing aerosol generating endoscopic procedures during the SARS-CoV-2 pandemic. Unfortunately, N95 respirator use is associated with the development of multiple symptoms. We wanted to study the frequency of various symptoms occurring in gastroenterologists using N95 respirators, the associated changes in various cardiorespiratory parameters, and possible underlying mechanisms leading to these.

While it is critical to protect healthcare workers during a pandemic, we feel it is also important to understand PPE-related adverse effects they may suffer as they deliver essential services. A better understanding of N95 respirator-related effects and underlying mechanisms will lead to mitigative measures.

A majority of gastroenterologists (~80%) reported symptoms with N95 respirator use while performing simulated colonoscopy. These included breathing difficulty, frustration, fatigue, and headache. Gastroenterologists who developed these symptoms had associated significant heart rate elevation. Respiratory plethysmography data indicated an immediate significant increase in the depth of breathing while using an N95 respirator that resolved with its removal (Figure 1). All the gastroenterologists showed the same pattern of decrease in sympathetic to vagal ratio and an increase in intra-cardiac sympathetic effect with N95 respirator use. Taken in context with existing data, we believe that N95 respirator use increases respiratory effort that results in the development of multiple other physiological consequences and symptoms through various pathways. Further studies exploring long-term consequences of these effects and mitigative steps are indicated.

Figure 1. Peak to trough amplitude (volts) averages across pre-N95, N95, and post-N95 time periods showed significant differences for the full study population in repeated measures Tukey HSD pairwise comparisons (P = .004). P values between each bar are pre-N95, .004; N95, .000; and post-N95, .419. CI, Confidence interval.

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