• Emre Karsli, Atakan Yilmaz, Aykut Kemancı, Omer Canacik, Mert Ozen, Murat Seyit, Levent Şahin, Alten Oskay, Ramazan Sabirli, and Ibrahim Turkcuer.
• Department of Emergency Medicine, Faculty of Medicine, Tınaztepe University, Izmir, Turkey.
• Ir J Med Sci. 2023 Apr 1; 192 (2): 853860853-860.

BackgroundWearing face shields and masks, which used to have very limited public use before the COVID-19 outbreak, has been highly recommended by organizations, such as CDC and WHO, during this pandemic period.AimsThe aim of this prospective study is to scrutinize the dynamic changes in vital parameters, change in end tidal CO2 (PETCO2) levels, the relationship of these changes with taking a break, and the subjective complaints caused by respiratory protection, while healthcare providers are performing their duties with the N95 mask.MethodsThe prospective cohort included 54 healthcare workers (doctors, nurses, paramedics) who worked in the respiratory unit of the emergency department (ED) and performed their duties by wearing valved N95 masks and face shields. The vital parameters and PETCO2 levels were measured at 0-4th-5th and 9th hours of the work-shift.ResultsOnly the decrease in diastolic BP between 0 and 9 h was statistically significant (p = 0.038). Besides, mean arterial pressure (MAP) values indicated a significant decrease between 0-9 h and 5-9 h (p = 0.024 and p = 0.049, respectively). In terms of the vital parameters of the subjects working with and without breaks, only PETCO2 levels of those working uninterruptedly increased significantly at the 4th hour in comparison to the beginning-of-shift baseline levels (p = 0.003).ConclusionAlthough the decrease in systolic blood pressure (SBP) and MAP values is assumed to be caused by increased fatigue due to workload and work pace as well as increase in muscle activity, the increase in PETCO2 levels in the ED healthcare staff working with no breaks between 0 and 4 h should be noted in terms of PPE-induced hypoventilation.© 2022. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.

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