Personal protective equipment-induced systemic hypercapnic hypoxaemia: translational implications for impaired cognitive–clinical functional performance

• Published in: British journal of surgery 2023-04, Vol.110 (5), p.606-613
• Main Authors: Luton, Oliver W, Stacey, Benjamin S, Mellor, Katie, James, Osian P, Williams, Ian M, Warren, Neil, Egan, Richard J, Bailey, Damian M, Lewis, Wyn G
• Format: Article
• Language: English
• Subjects: Cerebrovascular Circulation; Cognition; Cross-Over Studies; Female; Headache; Humans; Hypercapnia; Hypoxia; Male; Personal Protective Equipment - adverse effects
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1093/bjs/znad067

Abstract Background Personal protective equipment (PPE) adversely affects pulmonary gas exchange and may result in systemic hypercapnic hypoxaemia and headache. This study aimed to determine what extent PPE affects cerebral symptoms, global cerebral blood flow, and cognitive functional performance. Methods Higher surgical trainees participated in a randomized, repeated-measures, crossover study, completing 60 min of laparoscopic surgical simulation in both standard operating attire and type 3 PPE. Measurements were collected at baseline and after 60 min of simulation. The primary outcome measure was headache. Headache was examined using the validated visual analogue scale (VAS) and Environmental Symptoms Questionnaire C (ESQ-C), global cerebral blood flow with duplex ultrasonography, and visuospatial and executive gross/fine motor function with grooved peg board (GPB) and laparoscopic bead (LSB) board tasks. Results Thirty-one higher surgical trainees (20 men, 11 women) completed the study. Compared with standard operating attire, PPE increased headache assessment scores (mean(s.d.) VAS score 3.5(5.6) versus 13.0(3.7), P < 0.001; ESQ-C score 1.3(2.0) versus 5.9(5.1), P < 0.001) and was associated with poorer completion times for GPB-D (61.4(12.0) versus 71.1(12.4) s; P = 0.034) and LSB (192.5(66.9) versus 270.7(135.3) s; P = 0.025) tasks. Wearing PPE increased heart rate (82.5(13.6) versus 93.5(13.0) beats/min; P = 0.022) and skin temperature (36.6(0.4) versus 37.1(0.5)°C; P < 0.001), but decreased peripheral oxygen saturation (97.9(0.8) versus 96.8(1.0) per cent; P < 0.001). Female higher surgical trainees exhibited higher peripheral oxygen saturation across all conditions. No differences were observed in global cerebral blood flow as a function of attire, time or sex. Conclusion Despite no marked changes in global cerebral blood flow, type 3 PPE was associated with increased headache scores and cerebral symptoms (VAS and ESQ-C) alongside impaired executive motor function highlighting the clinical implications of PPE-induced impairment for cognitive–clinical performance. Personal protective equipment (PPE) adversely affects pulmonary gas exchange. This study aimed to determine to what extent these changes affect global cerebral blood flow, cognition, and manual dexterity. Thirty-one surgical trainees (20 men, 11 women), of mean(s.d.) age 29(2) years, participated in a randomized, single-blind, repeated-measures, crossover trial, completing 1 h of standard