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Title: Ventilatory parameters measured during a physiological study of simulated powered air-purifying respirator failure in healthy volunteers.
Austin Authors: Miles, Lachlan F ;Makar, Timothy;Oughton, Chad W;Peyton, Philip J 
Affiliation: Anaesthesia
Centre for Integrated Critical Care, The University of Melbourne, Melbourne, Australia
Issue Date: May-2021
Date: 2021-05-26
Publication information: Anaesthesia and Intensive Care 2021; 49(3): 206-213
Abstract: Powered air-purifying respirators (PAPR) are a high level of respiratory personal protective equipment. Like all mechanical devices, they are vulnerable to failure. The precise physiological consequences of failure in live subjects have not previously been reported. We conducted an observational safety study simulating PAPR failure in a group of nine healthy volunteers, wearing loose-fitting hoods, who were observed for a period of ten minutes, or until they requested the experiment be aborted, with continuous monitoring of gas exchange. Relative to baseline, participants demonstrated median reductions in peripheral oxygen saturation of 3.5% (95% confidence interval (CI) -4% to -2%; P = 0.0039) and fraction of inspired oxygen of 0.045 (95% CI -0.05 to -0.04; P = 0.0039), and median increases in inspired partial pressure of carbon dioxide of 27 mmHg (95% CI 23.5-32 mmHg; P = 0.0039), end-tidal partial pressure of carbon dioxide of 11 mmHg (95% CI 7-16 mmHg; P = 0.0039) and minute ventilation of 30 l/min (95% CI 19.4-35.9 l/min; P = 0.0039). Median collateral entrainment of room air into the hood was 17.6 l/min (interquartile range 12.3-27.0 l/min). All subjects reported thermal discomfort, with two (22.2%) requesting early termination of the experiment. Whilst the degree of rebreathing in this experiment was not sufficient to cause dangerous physiological derangement, the degree of reported thermal discomfort combined with the consequences of entrainment of possibly contaminated air into the hood, pose a risk to wearers in the event of failure.
DOI: 10.1177/0310057X20978982
ORCID: 0000-0003-2044-5560
Journal: Anaesthesia and Intensive Care
PubMed URL: 34039044
ISSN: 0310-057X
Type: Journal Article
Subjects: COVID-19
health personnel
personal protective devices
personal protective equipment (PPE)
respiratory function: dead space
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