Evaluation of N95 respirator use with a surgical mask cover: Effects on breathing resistance and inhaled carbon dioxide

Annals of Occupational Hygiene

Volumn 57, Issue 3, 2013, Pages 384-398

  Sinkule, Edward James ^a   Powell, Jeffrey Bryon ^a   Goss, Fredric Lee ^b  

^a NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTH   (United States)

^b UNIVERSITY OF PITTSBURGH   (United States)

Author keywords

Breathing resistance; Effects from using N95 respirators; Extending N95 respirators during influenza outbreak; Inhaled carbon dioxide; Inhaled oxygen; Metabolic simulator; N95 respirator; Respiratory protection; Surgical mask

Indexed keywords

ACTIVITY INTENSITIES; ENERGY EXPENDITURE; N95 FILTERING FACEPIECE RESPIRATORS; N95 RESPIRATORS; NATIONAL INSTITUTE FOR OCCUPATIONAL SAFETY AND HEALTHS; PANDEMIC INFLUENZA; RESPIRATORY PROTECTION; SURFACE CONTAMINATIONS;

AIR QUALITY; CARBON DIOXIDE; HEALTH CARE; METABOLISM; SURGERY;

RESPIRATORS;

CARBON DIOXIDE; OXYGEN;

ARTICLE; BREATHING; EQUIPMENT; FILTRATION; GAS MASK; HUMAN; INDOOR AIR POLLUTION; INFLUENZA; INHALATION; MASK; OCCUPATIONAL EXPOSURE; PANDEMIC; PARTICLE SIZE; PHYSIOLOGY; UTILIZATION REVIEW;

AIR POLLUTION, INDOOR; CARBON DIOXIDE; FILTRATION; HUMANS; INFLUENZA, HUMAN; INHALATION; MASKS; OCCUPATIONAL EXPOSURE; OXYGEN; PANDEMICS; PARTICLE SIZE; RESPIRATION; RESPIRATORY PROTECTIVE DEVICES;

EID: 84875197700     PISSN: 00034878     EISSN: 14753162     Source Type: Journal    
DOI: 10.1093/annhyg/mes068     Document Type: Article

References (36)

1. Ainsworth BE, Haskell WL, Whitt MC et al. (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exer; 32: S498-516.
2. Amann M, Romer LM, Pegelow DF et al. (2006) Effects of arterial oxygen content on peripheral locomotor muscle fatigue. J Appl Physiol; 101: 119-27.
3. American Conference of Governmental Industrial Hygienists. (2008) Occupational exposure values. Guide to occupational exposure values. Cincinnati, OH: American Conference of Governmental Industrial Hygienist.s.
4. Approval of Respiratory Protection Devices. (2006) 42 CFR 84.97 Test for carbon dioxide in inspired gas; open-and closed-circuit apparatus; maximal allowable limit.s.
5. Approval of Respiratory Protection Devices. (2011) 42 CFR 84.2(y) Definition.s.
6. Bennett ED, Jayson MI, Rubenstein D et al. (1962) The ability of man to detect added non-elastic loads to breathing. Clin Sci; 23: 155-62.
7. Campbell EJ, Freedman S, Smith PS et al. (1961) The ability of man to detect added elastic loads to breathing. Clin Sci; 20: 223-31.
8. Checkoway H, Pearce N, Kriebel D. (2004) Characterizing the workplace environment. Research methods in occupational epidemiology. New York, NY: Oxford University Press, Inc. ISBN 0-19-509242-2.
9. Compressed Gas Association. (1999) Carbon dioxide. Norwell, MA: Kluwer Academic Publisher.s.
10. Consolazio WV, Fisher MB, Pace N et al. (1947) Effects on man of high concentrations of carbon dioxide in relation to various oxygen pressures during exposures as long as 72 hours. Am J Physiol; 151: 479-503.
11. Cotes JE, Chinn DJ, Miller MR. (2006) Basic terminology and gas laws. Lung function: physiology, measurement and application in medicine. Malden, MA: Blackwell Publishing, Inc. ISBN 0-6320-6493-9.
12. Deno NS. (1984) Automatic breathing and metabolic simulator: the respiring robot. J Int Soc Respir Protect; 2: 38-51.
13. Harber P, Tamimie RJ, Bhattacharya A et al. (1982) Physiologic effects of respirator dead space and resistance loading. J Occup Med; 24: 681-9.
14. Hogan MC, Cox RH, Welch HG. (1983) Lactate accumulation during incremental exercise with varied inspired oxygen fractions. J Appl Physiol; 55: 1134-40.
15. Institute of Medicine, Committee on the Development of Reusable Facemasks for Use During an Influenza Pandemic. (2006) Use and reuse of respiratory protective devices for influenza control. Reusability of facemasks during an influenza pandemic: facing the flu. Washington, D.C.: The National Academies Press. ISBN: 0-309-66000-9.
16. Kyriazi N. (1986) Development of an automated breathing and metabolic simulator. Pittsburgh, PA: U.S. Department of the Interior, Bureau of Mines, IC 9110.
17. Li Y, Tokura H, Guo YP et al. (2005) Effects of wearing N95 and surgical facemasks on heart rate, thermal stress and subjective sensations. Int Arch Occup Environ Health; 78: 501-9.
18. Lim ECH, Seet RCS, Lee KH et al. (2006) Headaches and the N95 face-mask amongst healthcare providers. Acta Neurol Scand; 113: 199-202.
19. Louhevaara VA. (1984) Physiological-effects associated with the use of respiratory protective devices-a review. Scand J Work Environ Health; 10: 275-81.
20. National Institute for Occupational Safety and Health. Certified equipment list. Available from http://www.cdc.gov/niosh/npptl/topics/ respirators/cel/default.html (accessed 13 May 2011).
21. National Institute for Occupational Safety and Health. CETAPRS-STP-CBRN-0454: Determination of Human Subject Breathing Gas (HSBG) Concentrations (Carbon Dioxide and Oxygen) for Chemical, Biological, Radiological and Nuclear (CBRN) Air-Purifying Escape Respirator. Available from http://www.cdc.gov/niosh/npptl/stps/pdfs/CET-APRSSTP-CBRN-0454.pdf (accessed 25 August 2006).
22. Nieuwenhuijsen MJ. (2006) Introduction to exposure assessment. In Nieuwenhuijsen, MJ, editor. Exposure assessment in occupational and environmental epidemiology. New York, NY: Oxford University Press, Inc. ISBN 0-19-852861-2.
23. Patterson JL, Jr., Heyman A, Battey LL et al. (1955) Threshold of response of the cerebral vessels of man to increase in blood carbon dioxide. J Clin Invest; 34: 1857-64.
24. Radonovich LJ, Cheng J, Shenal BV et al. (2009) Respirator tolerance in health care workers. J Am Med Assoc; 301: 36-8.
25. Raven PB, Dodson AT, Davis TO. (1979) The physiological consequences of wearing industrial respirators: a review. Am Ind Hyg Assoc J; 40: 517-34.
26. Roberge RJ. (2008) Effect of surgical masks worn concurrently over N95 filtering facepiece respirators: extended service life versus increased user burden. J Public Health Manag Pract; 14: E19-26.
27. Roberge RJ, Coca A, Williams WJ et al. (2010) Surgical mask placement over N95 filtering facepiece respirators: physiological effects on healthcare workers. Respirology; 15: 516-21.
28. Sayers JA, Smith RE, Holland RL et al. (1987) Effects of carbon dioxide on mental performance. J Appl Physiol; 63: 25-30.
29. Schneider EC, Truesdale D. (1922) The effects on the circulation and respiration of an increase in the carbon dioxide content of the blood in man. Am J Physiol; 63: 155-75.
30. Schulte JH. (1964) Sealed environments in relation to health and disease. Arch Environ Health; 8: 438-52.
31. Sinkule E, Turner N, Hota S. (2003) Automated breathing and metabolic simulator (ABMS) CO2 test for powered and non-powered air-purifying respirators, airline respirators, and gas masks. American Industrial Hygiene Conference and Exposition (Abstracts); 54.
32. Sinkule EJ, Turner NL. (2004) Inhaled carbon dioxide and oxygen concentrations during rest and exercise of three airpurifying escape hoods. Med Sci Sports Exer; 36: S245.
33. U.S. Department of Health and Human Services. (2009) Authorization of emergency use of certain personal respiratory protection devices; Availability, 74 Federal Register 38644. Available from http://www. federalregister.gov/ articles/2009/08/04/E9-18570/authorization-of-emergency-use-of-certain- personalrespi ratory-protect ion-devices-availabi l ity#h-9 (accessed 2 November 2010).
34. Vojtko MR, Roberge MR, Vojtko RJ et al. (2008) Effect on breathing resistance of a surgical mask worn over a N95 filtering facepiece respirator. J Int Soc Respir Protect; 25: 1-8.
35. Whipp BJ, Davis JA, Wasserman K. (1989) Ventilatory control of the 'isocapnic buffering' region in rapidly-incremental exercise. Respir Physiol; 76: 357-67.
36. Yang Y, Sun C, Sun M. (1997) The effect of moderately increased CO2 concentration on perception of coherent motion. Aviat Space Environ Med; 68: 187-91.