The effect of mask usage of the health personnel on blood gas analysis and cognitive strengthening during COVID-19 pandemic

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In this process, the possibility of developing intermittent, long-term hypoxia and hypercarbia due to the use of masks has been considered in detail. Therefore, the negative physiological and psychological effects of this equipment in intensive care unit by healthcare personnel have become questionable. The present study is aimed to investigate the effect of mask use on blood gas analysis values and cognitive functions in intensive care unit healthcare workers. Materials and methods After obtaining local ethics committee approval (Grant number: …) and written informed consent, healthcare professionals working in the 3rd level intensive care unit of xxx City Training and Research Hospital were included in the study. Each volunteer's venous blood gas analysis were studied at the beginning and end of the eight-hour morning-shift period. Venous blood gas values including pH, venous partial oxygen pressure, venous partial carbon dioxide pressure, lactate levels were recorded. A five-question survey was applied to the same volunteers and their cognitive function performance during the pandemic period was evaluated. Results Intragroup comparisons for the N95 group revealed that pH-2nd measurement was found to be significantly higher than pH-1st measurement and Lactate-1st measurement was significantly higher than Lactate-2nd measurement (p = 0.002, p = 0.004, p = 0.002, p = 0.018, respectively. Conclusion Impairment in cognitive functions in intensive care workers using masks during the pandemic period can be explained by the development of intermittent long-term moderate hypoxia. Masks Surgical attire Coronavirus Carbon Dioxide Hypercapnia Introduction The cause of coronavirus disease (COVID-19) is SARS-CoV-2 virus. The developing pandemic has caused the death of more than five million people around the world since November 17, 2019, and caused millions of people to be treated in the intensive care unit with respiratory support [ 1 ]. In this process, the necessity of using personal protective equipment especially in intensive care workers and the prolongation of the pandemic period inevitably brought along a series of health problems among the workers [ 2 ]. Working conditions, such as long and strict use of masks, especially N-95 and surgical masks, of intensive care workers, uncertainties at the beginning of the pandemic, and equipment deficiencies, have shown their effects as important stressors [ 1 , 2 ]. The possibility of developing intermittent, long-term hypoxia and hypercarbia due to the use of masks among healthcare workers during the study period has been considered in detail. In relation, negative physiological and psychological effects of this equipment in intensive care workers have become questionable. A detailed reviw of the literature showed that there are few studies on this subject and it is difficult to express a definite result [ 2 – 4 ]. Therefore, the present study is aimed to investigate the effect of mask use on blood gas analysis values and cognitive functions in intensive care unit workers. Materials And Methods After obtaining approval from the Mersin University Clinical Research Ethics Committee (Grant number: 23.03.2022/201), ..... Şehir Training and Research Hospital and written informed consent, healthcare professionals whose aged between 20 and 60 years and did not have a malignant, chronic systemic disease working in the 3rd level intensive care unit of xxx City Training and Research Hospital were included in this prospective study. Each volunteer would have a time period of 90 minutes for a break to go out of the working environment during the eight-hour working period. Venous blood samples were taken from the personnel at the beginning of the shift (Sample 1) and eight hours later (Sample 2). Blood gas analysis was performed simultaneously in the blood gas analysis device (tarde mark, city, country) in the intensive care unit without any delay. Venous blood gas analysis values including pH, venous partial oxygen pressure (vpO2), venous partial carbon dioxide pressure (vpCO2), and lactate levels were recorded. A five-item survey was applied to the same volunteers and their cognitive function performance during the pandemic period was evaluated. Statistical analysis The distributions of the data were analyzed with the Kolmogorov-Smirnov test. Categorical data were presented as numbers and percentages, and numerical data as mean and standard deviation. Chi-square test was used to compare categorical data. The comparison of blood gas analysis results according to the type of mask used was performed by Mann-Whitney U test, where intragroup comparisons were completed using Wilcoxon test. All analyzes were completed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) version 20 program. Statistical significance was accepted as p < 0.05 in all analyzes. Results A total of 63 patients were included in the study. One volunteer's data were excluded for technical reasons. Of those included, 20 (31.7%) were men and 43 (68.3%) were women. The mean age of all volunteers was 33.53 ± 6.76. The demographic data of the volunteers by groups with blood gas analysis results are shown in Table 1 , the results of the questionnaires are displayed in Table 2 . Intragroup comparisons for the surgical mask group showed that pH-2nd measurement was found to be significantly higher than pH-1.measurement and pO 2 -1st measurement was significantly higher than pO 2 -2nd measurement. Intragroup comparisons for the N95 group revealed that pH-2nd measurement was found to be significantly higher than pH-1st measurement and Lactate-1st measurement was significantly higher than Lactate-2nd measurement (p = 0.002, p = 0.004, p = 0.002, p = 0.018, respectively; Table-1). Table 1 Demographic characteristics and blood gas analysis results of the participants Mask type P Surgical mask N95 N (%) N (%) Gender Female 16 (76.2) 27 (64.3) 0.339 Male 5 (23.8) 15 (35.7) (Mean ± SD) (Mean ± SD) Age (years) 35.95 ± 0.76 32.38 ± 6.54 pH-1st measurement 7.35 ± 0.026 7.35 ± 0.028 0.481 pO 2 -1st measurement 33.12 ± 11.31 34.26 ± 12.53 0.683 pCO 2 -1st measurement 45.43 ± 12.09 45.95 ± 10.47 0.771 satO 2 -1st measurement 39.85 ± 18.83 40.84 ± 20.29 0.971 Lactate-1st measurement 0.69 ± 0.38 0.84 ± 0.40 0.258 pH-2nd measurement 7.37 ± 0.034 7.37 ± 0.030 0.681 pO 2 -2nd measurement 30.04 ± 11.18 32.99 ± 10.12 0.255 pCO 2 -2nd measurement 43.14 ± 13.03 46.04 ± 8.39 0.683 satO 2 -2nd measurement 38.82 ± 18.42 44.84 ± 20.32 0.238 Lactate-2nd measurement 0.62 ± 0.27 0.72 ± 0.36 0.389 *p < 0.05 Mann-Whitney U test. Wilcoxon test Intragroup comparisons for surgical mask group; pH-1st measurement – pH-2nd measurement: p = 0.002; pO 2 -1st measurement – pO 2 -2nd measurement: p = 0.004; pCO 2 -1st measurement – pCO 2 -2nd measurement: p = 0.394; satO 2 -1st measurement – satO 2 -2nd measurement: p = 0.566; Lactate-1st measurement – Laktat-2nd measurement: p = 0.267 Intragroup comparisons for N95 mask group; pH-1st measurement – pH-2nd measurement: p = 0.002; pO 2 -1st measurement – pO 2 -2nd measurement: p = 0.160; pCO 2 -1st measurement – pCO 2 -2nd measurement: p = 0.764; satO 2 -1st measurement – satO 2 -2nd measurement: p = 0.468; Lactate-1st measurement – Lactate-2nd measurement: p = 0.018 Table 2 The results of the survey Mask type P Surgical mask N95 N (%) N (%) I’m nervous (Yes) 7 (33.3) 14 (33.3) > 0.05 I am forgetful (Yes) 7 (33.3) 23 (54.8) 0.108 I am having trouble on focusing (Yes) 7 (33.3) 14 (33.3) > 0.05 I have distraction problem (Yes) 9 (42.9) 13 (31) 0.350 I am getting tired quickly (Yes) 14 (66.7) 28 (66.7) > 0.05 I am not as patient as before (Yes) 12 (57.1) 16 (38.1) 0.151 I use more painkillers than before (Yes) 9 (42.9) 16 (38.1) 0.716 I had COVID-19 (Yes) 16 (76.2) 28 (66.7) 0.437 *p < 0.05 Chi-square test Discussion In this study, it was found that the pO 2 value decreased after eight hours of surgical masks usage in healthy volunteers, the pH value increased in both mask groups and the lactate value decreased in N95 mask group. However, it was determined that cognitive functions were affected in N95 mask group compared to the surgical mask group. During the COVID-19 pandemic, severe psychological changes including anxiety and depression were frequently observed accompanying to significant negative changes in cognitive functions such as memory weakness, focusing problems, and irritability in intensive care workers [ 2 – 4 ]. As in aviation, flight and underwater diving environments, especially in environments where protective masks are used due to pandemics, there are those who say that chronic hypoxia at different levels has negative effects on the central nervous system, especially on cognitive functions, as well as those who state that it has positive effects [ 4 , 5 ]. In our study, it was observed that moderate hypoxia developed in some of the volunteers as a result of the eight-hour study. The vpO 2 . 2nd measurement in both single use three-ply surgical mask and N95 mask group was found to be low compared to vpO 2 -1st measurement at the end of eight hours. In relation, the vpO 2 values of the intensive care workers using two different types of masks were lower at the end of eight-hour period than the value at the beginning of the study. Studies evaluating blood gas analysis revealed a strong correlation between venous and arterial blood gas samples for pCO 2 , pH values, and a weak correlation for pO 2 and satO 2 values. They stated that venous blood gas can still provide information about respiratory functions [ 6 , 7 ]. Despite showing no change in vpCO 2 level in N95 mask group in the present study, vpCO2 was found to be significantly lower at the end of eight hours in workers using three-ply surgical masks. This result suggests that three-ply surgical masks may have allowed CO 2 leakage from the mask, and that those who use N95 masks may have re-breathed some of their exhailed air. Studies have shown that hypercarbia under mask initially developed during the adaptation process to the mask which is rapidly returned to normal levels. In the present study, this mechanism could be explained by the involvement of the compensatory respiratory dynamics [ 8 , 9 ]. Despite the pH values of the volunteers used both types of masks were found to be higher after eight hours, this difference was not considered clinically significant. Similar to the measured pH value, the decline in lactate level in N95 mask group was also not accepted as a clinically significant decrease. Furthermore, Robberge et al. conducted a study on ten healthcare workers using filter mask for one hour, and they reported that carbon dioxide and oxygen levels were found to be reached significantly above the standards accepted for the workplace. They concluded that using a valve mask did not improve the pCO 2 level [ 9 ]. Li et al. reported that there was a decrease in tidal volume and some cardiopulmonary parameters in volunteers using surgical mask and no mask. They stated that the decrease in those parameters suggests that muscle mitochondria may reduce the ability to use oxygen thus affecting exercise capacity [ 8 ]. Blood gas analysis revealed negative effects of long-term use of protective masks on the central nervous system, cardiovascular system and respiratory system [ 3 , 8 , 9 ]. The present study demonstrated that vpO 2 -2nd measurement in both mask groups was lower than the vpO 2 -1st measurement, and the presence of long-term intermittent low-level hypoxia had negative effects on cognitive and physical functions as reported in previous studies [ 8 , 10 – 13 ]. In this study, volunteers declared cognitive dysfunction such as “I am forgetful”, “ I am having trouble on focusing ”, “ I have distraction problem ” ranged from 33.3–54.8%. In addition, the rate of those who mentioned “I get tired quickly”, “I am nervous”, and “I am not as patient as before” was between 33.3% and 66.7%. Impairment in cognitive functions and negative behavioral changes were remarkable in intensive care workers. In this regard, Champod et al. found that intermittent hypoxia had a negative effect on learning and memory [ 13 ]. It is known that the duration of mask use by healthcare workers was long and it continued recursively at varying intervals over time during COVID-19 pandemic. It has been stated in different studies that the possibility of developing intermittent and long-term hypoxia and hypercarbia could not be underestimated [ 3 , 4 , 9 ]. The most remarkable study among the studies conducted to date is the study of Vakharia et al. on sixty volunteers [ 14 ]. The authors conducted two groups, the three-ply mask and N95 mask group in which brain oxygenation was evaluated with cerebral blood oxygenation level dependent magnetic resonance imaging (BOLD MR) at the beginning of the shift and at the end of the six-hour shift. Headache was the most common symptom in both groups in their study. In addition, clinical symptoms such as nausea, vomiting, dizziness, blurred vision, drowsiness and fatigue were observed more frequently in N95 group, but also in the group using both types of masks [ 14 ]. In our study, it was observed that painkillers were used at a rate varying between 38.1% and 42.9% among all mask groups in healthcare workers compared to before during the pandemic. The pathophysiology of cerebral hypoxia is complex and multifactorial, and the severity and duration of hypoxia are important. In this context, hypoxia is defined under two headings as acute hypoxic hypoxia and chronic hypoxic hypoxia [ 15 – 17 ]. A broad definition can be made for the duration of acute hypoxia and chronic hypoxia from seconds, hours, days and years. Cerebral vascular vessels respond with a change in vessel diameter when the pO 2 level decreases below 50 mmHg and in hypercapnia. Carbon dioxide is a potent vasodilator by leading to dilatation of the pial vessels, and a decrease in vascular resistance resulting an increase in cerebral blood flow (CCA). Vasodilation also occurs in the intracranial and extracranial arteries, carotid and vertebral arteries. In chronic hypoxia, blood is directed to vital centers in the brain stem. While cellular oxygenation is maintained, other non-vital brain regions remain relatively hypoxic [ 18 ]. Cerebral oxygenation is affected in the frontal lobe and anterior cingulate gyri. These regions manage the compensation mechanism for cognitive functions. The clinical mechanism of confusion was also explained in the study of Vakharia et al. by the demonstration of insufficient blood redistribution and compensation using BOLD MR in seven subjects[ 14 , 15 , 18 ]. However, it is seen that there is still no consensus on what and how to use the definition of "intermittent hypoxia" [ 10 , 11 ]. It has been stated that the effect of intermittent hypoxia on many organ systems is related to various variables (hypoxemia severity, hypoxia duration, number of cycles/day, intermittent hypoxia pattern-intermittent hypoxia-intermittent, consecutive days, total number of days) [ 8 , 10 ]. When the neurophysiological basis of the effects of hypoxia on cognitive functions is examined, it has been reported that it causes some disorders ranging from metabolic homeostasis to the deterioration of neural integrity by causing molecular damage, depending on the severity of hypoxia. Cognitive functions such as attention, information storage, retrieval as well as processing speed are supported by many large-scale neural networks. The primary and sensory cortex with some of parietal and frontal regions join this network anteriorly. It has been shown that these regions are affected in hypoxic and ischemic memory disorders. It has been reported in various studies that there are regions of the brain that are sensitive to oxygen deficiency, especially those that are closely related to cognitive functions [ 5 , 19 , 20 ]. The effects of hypoxia on central nervous and cardiovascular system, and the cellular changes that have been shown to affect the mental state, may be sufficient to explain the response of the intensive care workers that we have observed in our study as "I get tired more quickly". In addition to these, it is not difficult to say that heavy working conditions may have an accumulated stress effect during the pandemic process. Mecit et al. showed an increase in burnout syndrome where anxiety and depression was observed during the pandemic process. Similarly in previous studies, the remarkable number of people those indicated that they were angry and not as patient as they used to be in the present study, supports the existence of psychological fluctuations ranging from anxiety to burnout syndrome during the pandemic [ 3 ]. There are some limitations in the study. First, the number of patients and nationality is focused on one and small limiting the generatability of the findings of the present study. Second, arterial blood gas analysis might obtain detailed results compared to venous gas analysis however arterial access is an an invasive procedure thus restricting the feasibility of the procedure. Conclusion Impairment in cognitive functions in intensive care workers using masks during the pandemic period can be explained by the development of intermittent long-term moderate hypoxia.. In addition, intensive care working conditions during the pandemic have been an important stress factor that also reveals somatic symptoms. It should also be noted that in the pre-vaccination period of the pandemic, when there are many unknowns, some of the healthcare professionals resort to much more conservative protective methods, such as the use of double masks. There is a need for comprehensive studies on the development of masks that offer more comfortable breathing. Declarations Authorcontributions HO: Conceptualization, Investigation, Methodology, Writing, Original Draft Preparation SD: Conceptualization, Analysis Investigation, Validatio Writing, Supervision BA: Conceptualization, Investigation, Writing , Methodology, Writing, Supervision HEE: Formal Analysis Investigation, Project Administrator: H O Funding The authors have not disclosed any funding. It wıll be present as an oral presentatıon ın TARK 2022 Congress Conflict of interest The authors have no relevant financial or non-financial interests to disclose. Ethical approval The study was approved by the ethical committee of Mersin University Clinical Research Ethics Committee (Grant number: 23.03.2022/201) Consent to participate Informed consent was obtained from all individual participants included in the study. References Silva FCT, Barbosa CP. The impact of the COVID-19 pandemic in an intensive care unit (ICU): Psychiatric symptoms in healthcare professionals. Progress in Neuropsychopharmacology & Biological Psychiatry. 2021;299(110):1–14. Scheid JL, Lupien SP, Ford GS, West SL 4. Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemic: Int. J. Environ. Res. Public Health: 2020, 17, 6655; doi: 10.3390/ijerph17186655 . Mecit BBT, Opak S, Yıldırım ÖD, Sıvacı RG. COVID-19 Burnout Level of Health Staff Working and not Working in Intensive Care Units: JARSS. 2022;30(2):84–8 doi: 10.54875/jarss.2022.27928 . Ando S, Komiyama T, Sudo, et al. The interactive effects of acute exercise and hypoxia on cognitive performance: A narrative review. First published: 12 October 2019.Scandınavıan Journal Of Medicine &Science ın Sports.Revıew Artıcle https://doi.org/10.1111/sms.13573 . Ilbasmış MS. The effect of aerobic and anaerobic exercise capacity on psychomotor and cognitive performance in hypoxia. PhD Thesis. 2017.31-35 (Hipokside, aerobik ve anaerobik egzersiz kapasitesinin psikomotor ve kognitif performansa etkisi. Doktora Tezi).2017. 31–55. Thangaraj RK, Chidambaram HHS, Dominic M, et al. A Comparison of Arterial and Venous Blood Gas Analysis and Its Interpretation in Emergency Department: A Cross-Sectional Study. Eurasian J Emerg Med. 2021;20(3):178–82. doi: 10.4274/eajem.galenos.2021.85520 . Bakoğlu E, Kebapçıoğlu AS, Ak A, Girişgin AS, Zararsız İ. Investigation of the Utility of Peripheral Venous Blood Gas Instead of Arterial Blood Gas in The Emergency Department. Eur J Basic Med Sci. 2013;3(2):29–33. Li M, Ou H, Li Q et al . Effects of Surgical Masks on Cardiopulmonary Function in Healthy Subjects : J Vis Exp . 2021 Feb 12 ;( 168 ). doi : 10 . 3791 / 62121 . Published : February 12 , 2021 doi : 10.3791/62121 . Roberge RJ, et al. Physiological Impact of the N95 Filtering Facepiece Respirator on Healthcare Workers. Respir Care. 2010;55(5):569–77]. Opazo AN. G S. Therapeutic potential of intermittent hypoxia: a matter of dose Am J Physiol Regul Integr Comp Physiol. 2014 Nov 15; 307(10): R1181–R1197. doi: 10.1152/ajpregu.00208.2014 . Öztürk L, Metin G, Pelin Z. Intermittent hypoxia and physiological adjustment: Respiratory. 2003; 5: 121–126. Martin MS, Sforza E, Roche F, Barthélémy JC, Thomas-Anterion C. Sleep Breathing Disorders and Cognitive Function in the Elderly: An 8-Year Follow-up Study: The Proof-Synapse Cohort. 2015 Feb 1; 38(2): 179–187. doi: 10.5665/sleep.4392 . Champod AS, Eskes GA, Foster GE, Hanly PJ, Pialoux V, Beaudin AE, Poulin MJ. Effects of acute intermittent hypoxia on working memory in young healthy adults. Am J Respir Crit Care Med. 2013 May;15(10):1148–50. doi: 10.1164/rccm.201209-1742LE . 187 ). Vakharia RJ, Jani I, Yadav S, Kurian T. To Study Acute Changes in Brain Oxygenation on MRI in Healthcare Workers Using N95 Mask and PPE Kits for Six Hours a Day. Indian J Radiol Imaging. 2021;31:893–900. Lawley JS, Macdonald JH, Oliver SJ, Mullins PG. Unexpected reductions in regional cerebral perfusion during prolonged hypoxia. J Physiol. 2017.;595(03):935–947. Mikhail Kellawan J, Harrell JW, Roldan-Alzate A, Wieben O, Schrage WG. Regional hypoxic cerebral vasodilation facilitated by diameter changes primarily in anterior versus posterior circulation: J Cereb Blood Flow Metab. 2017.;37(06):2025–2034. Nakahata K, Kinoshita H, Hirano Y. Mild hypercapnia induces vasodilation via adenosine triphosphate-sensitive K + in parenhcymal microvessels of the rat cerebral cortex. Anesthesiology. 2003;99:1333–9. Binks AP, Cunningham VJ, Adams L, Banzett RB. Gray matter blood flow change is unevenly distributed during moderate isocapnic hypoxia in humans. J Appl Physiol (1985). 2008;104(01):212–7. Turner CE, Barker-Collo SL, Connell CJW, Gant N. Acute hypoxic gas breathing severely impairs cognition and task learning in humans: 2015 Apr 1;142:104 – 10. doi: 10.1016/j.physbeh.2015.02.006. Epub 2015 Feb 4. Buckler KJ, Turner PJ. Functional Properties of Mitochondria in the Type-1 Cell and Their Role in Oxygen Sensing. Adv Exp Med Biol. 2015;860:69–80. doi: 10.1007/978-3-319-18440-1_9 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 20 Mar, 2024 Read the published version in Journal of the Pakistan Medical Association → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2066014","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":137202614,"identity":"d3af3868-7ef3-4df9-a8dc-efc5d3d52211","order_by":0,"name":"Harun OZMEN","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYBACAygtByIOPCBFizFYSwIpWhIbQCRRWsylzx58+DPnTvr8sMMPgbbYyek2ENBi2ZeXbCC57VnuxttpBkAtycZmBwg57AyPmYThtsO5G2cngLQcSNxGlJbEbYfTDWenfyBBy8FthxPkpXOIt8XYsHHbYcMN0jkFBxIMiPOL4cOf2w7Ly89O3/zhQ4WdHEEtCL1glQYEVKEA+QZSVI+CUTAKRsGIAgBWMUa2/aDvNwAAAABJRU5ErkJggg==","orcid":"","institution":"University of Health Sciences","correspondingAuthor":true,"prefix":"","firstName":"Harun","middleName":"","lastName":"OZMEN","suffix":""},{"id":137202615,"identity":"b8d621b1-275f-4557-b1af-eca96a857817","order_by":1,"name":"Bahar AYDINLI","email":"","orcid":"","institution":"University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Bahar","middleName":"","lastName":"AYDINLI","suffix":""},{"id":137202616,"identity":"c7c7532c-416a-4581-bd29-3081d224a74a","order_by":2,"name":"Serkan DOGRU","email":"","orcid":"","institution":"University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Serkan","middleName":"","lastName":"DOGRU","suffix":""},{"id":137202617,"identity":"f353f120-df02-4e61-8ef7-1da568c0a365","order_by":3,"name":"Huseyin Erdi Erdem","email":"","orcid":"","institution":"University of Health Sciences","correspondingAuthor":false,"prefix":"","firstName":"Huseyin","middleName":"Erdi","lastName":"Erdem","suffix":""}],"badges":[],"createdAt":"2022-09-14 17:44:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2066014/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2066014/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.47391/JPMA.9243","type":"published","date":"2024-03-20T05:45:51+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":53529156,"identity":"0bec1552-7f79-4e31-88a9-3aa38abefaa6","added_by":"auto","created_at":"2024-03-27 05:45:55","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":389517,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2066014/v1/a3424a60-fb08-4638-80d2-3b3752f3427e.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The effect of mask usage of the health personnel on blood gas analysis and cognitive strengthening during COVID-19 pandemic","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe cause of coronavirus disease (COVID-19) is SARS-CoV-2 virus. The developing pandemic has caused the death of more than five million people around the world since November 17, 2019, and caused millions of people to be treated in the intensive care unit with respiratory support [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In this process, the necessity of using personal protective equipment especially in intensive care workers and the prolongation of the pandemic period inevitably brought along a series of health problems among the workers [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Working conditions, such as long and strict use of masks, especially N-95 and surgical masks, of intensive care workers, uncertainties at the beginning of the pandemic, and equipment deficiencies, have shown their effects as important stressors [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The possibility of developing intermittent, long-term hypoxia and hypercarbia due to the use of masks among healthcare workers during the study period has been considered in detail. In relation, negative physiological and psychological effects of this equipment in intensive care workers have become questionable. A detailed reviw of the literature showed that there are few studies on this subject and it is difficult to express a definite result [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Therefore, the present study is aimed to investigate the effect of mask use on blood gas analysis values and cognitive functions in intensive care unit workers.\u003c/p\u003e"},{"header":"Materials And Methods","content":"\u003cp\u003e After obtaining approval from the Mersin University Clinical Research Ethics Committee (Grant number: 23.03.2022/201), ..... Şehir Training and Research Hospital and written informed consent, healthcare professionals whose aged between 20 and 60 years and did not have a malignant, chronic systemic disease working in the 3rd level intensive care unit of xxx City Training and Research Hospital were included in this prospective study. Each volunteer would have a time period of 90 minutes for a break to go out of the working environment during the eight-hour working period. Venous blood samples were taken from the personnel at the beginning of the shift (Sample 1) and eight hours later (Sample 2). Blood gas analysis was performed simultaneously in the blood gas analysis device (tarde mark, city, country) in the intensive care unit without any delay. Venous blood gas analysis values including pH, venous partial oxygen pressure (vpO2), venous partial carbon dioxide pressure (vpCO2), and lactate levels were recorded. A five-item survey was applied to the same volunteers and their cognitive function performance during the pandemic period was evaluated.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eThe distributions of the data were analyzed with the Kolmogorov-Smirnov test. Categorical data were presented as numbers and percentages, and numerical data as mean and standard deviation. Chi-square test was used to compare categorical data. The comparison of blood gas analysis results according to the type of mask used was performed by Mann-Whitney U test, where intragroup comparisons were completed using Wilcoxon test. All analyzes were completed using Statistical Package for Social Sciences (SPSS Inc., Chicago, IL) version 20 program. Statistical significance was accepted as p\u0026thinsp;\u0026lt;\u0026thinsp;0.05 in all analyzes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 63 patients were included in the study. One volunteer's data were excluded for technical reasons. Of those included, 20 (31.7%) were men and 43 (68.3%) were women. The mean age of all volunteers was 33.53\u0026thinsp;\u0026plusmn;\u0026thinsp;6.76. The demographic data of the volunteers by groups with blood gas analysis results are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, the results of the questionnaires are displayed in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. Intragroup comparisons for the surgical mask group showed that pH-2nd measurement was found to be significantly higher than pH-1.measurement and pO\u003csub\u003e2\u003c/sub\u003e-1st measurement was significantly higher than pO\u003csub\u003e2\u003c/sub\u003e-2nd measurement. Intragroup comparisons for the N95 group revealed that pH-2nd measurement was found to be significantly higher than pH-1st measurement and Lactate-1st measurement was significantly higher than Lactate-2nd measurement (p\u0026thinsp;=\u0026thinsp;0.002, p\u0026thinsp;=\u0026thinsp;0.004, p\u0026thinsp;=\u0026thinsp;0.002, p\u0026thinsp;=\u0026thinsp;0.018, respectively; Table-1).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic characteristics and blood gas analysis results of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" morerows=\"2\" nameend=\"c2\" namest=\"c1\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e \u003cp\u003eMask type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSurgical mask\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eN95\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eFemale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (76.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27 (64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMale\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (23.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (35.7)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e(Mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.95\u0026thinsp;\u0026plusmn;\u0026thinsp;0.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.38\u0026thinsp;\u0026plusmn;\u0026thinsp;6.54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003epH-1st measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.35\u0026thinsp;\u0026plusmn;\u0026thinsp;0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.481\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003epO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e-1st measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.12\u0026thinsp;\u0026plusmn;\u0026thinsp;11.31\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e34.26\u0026thinsp;\u0026plusmn;\u0026thinsp;12.53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003epCO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e-1st measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45.43\u0026thinsp;\u0026plusmn;\u0026thinsp;12.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45.95\u0026thinsp;\u0026plusmn;\u0026thinsp;10.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.771\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003esatO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e-1st measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.85\u0026thinsp;\u0026plusmn;\u0026thinsp;18.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40.84\u0026thinsp;\u0026plusmn;\u0026thinsp;20.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.971\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLactate-1st measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.69\u0026thinsp;\u0026plusmn;\u0026thinsp;0.38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.84\u0026thinsp;\u0026plusmn;\u0026thinsp;0.40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.258\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003epH-2nd measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.034\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7.37\u0026thinsp;\u0026plusmn;\u0026thinsp;0.030\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003epO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e-2nd measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.04\u0026thinsp;\u0026plusmn;\u0026thinsp;11.18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e32.99\u0026thinsp;\u0026plusmn;\u0026thinsp;10.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.255\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003epCO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e-2nd measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.14\u0026thinsp;\u0026plusmn;\u0026thinsp;13.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e46.04\u0026thinsp;\u0026plusmn;\u0026thinsp;8.39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.683\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003esatO\u003c/b\u003e\u003csub\u003e\u003cb\u003e2\u003c/b\u003e\u003c/sub\u003e\u003cb\u003e-2nd measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.82\u0026thinsp;\u0026plusmn;\u0026thinsp;18.42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e44.84\u0026thinsp;\u0026plusmn;\u0026thinsp;20.32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLactate-2nd measurement\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.62\u0026thinsp;\u0026plusmn;\u0026thinsp;0.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72\u0026thinsp;\u0026plusmn;\u0026thinsp;0.36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eMann-Whitney U test.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eWilcoxon test\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparisons for surgical mask group;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003epH-1st measurement \u0026ndash; pH-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.002; pO\u003csub\u003e2\u003c/sub\u003e-1st measurement \u0026ndash; pO\u003csub\u003e2\u003c/sub\u003e-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.004; pCO\u003csub\u003e2\u003c/sub\u003e-1st measurement \u0026ndash; pCO\u003csub\u003e2\u003c/sub\u003e-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.394; satO\u003csub\u003e2\u003c/sub\u003e-1st measurement \u0026ndash; satO\u003csub\u003e2\u003c/sub\u003e-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.566; Lactate-1st measurement \u0026ndash; Laktat-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.267\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntragroup comparisons for N95 mask group;\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003epH-1st measurement \u0026ndash; pH-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.002; pO\u003csub\u003e2\u003c/sub\u003e-1st measurement \u0026ndash; pO\u003csub\u003e2\u003c/sub\u003e-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.160; pCO\u003csub\u003e2\u003c/sub\u003e-1st measurement \u0026ndash; pCO\u003csub\u003e2\u003c/sub\u003e-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.764; satO\u003csub\u003e2\u003c/sub\u003e-1st measurement \u0026ndash; satO\u003csub\u003e2\u003c/sub\u003e-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.468; Lactate-1st measurement \u0026ndash; Lactate-2nd measurement: p\u0026thinsp;=\u0026thinsp;0.018\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe results of the survey\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMask type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eSurgical mask\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eN95\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eN (%)\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI\u0026rsquo;m nervous (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am forgetful (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e23 (54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am having trouble on focusing (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (33.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI have distraction problem (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am getting tired quickly (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;0.05\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI am not as patient as before (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (57.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI use more painkillers than before (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.716\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI had COVID-19 (Yes)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (76.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28 (66.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.437\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003eChi-square test\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, it was found that the pO\u003csub\u003e2\u003c/sub\u003e value decreased after eight hours of surgical masks usage in healthy volunteers, the pH value increased in both mask groups and the lactate value decreased in N95 mask group. However, it was determined that cognitive functions were affected in N95 mask group compared to the surgical mask group. During the COVID-19 pandemic, severe psychological changes including anxiety and depression were frequently observed accompanying to significant negative changes in cognitive functions such as memory weakness, focusing problems, and irritability in intensive care workers [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. As in aviation, flight and underwater diving environments, especially in environments where protective masks are used due to pandemics, there are those who say that chronic hypoxia at different levels has negative effects on the central nervous system, especially on cognitive functions, as well as those who state that it has positive effects [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, it was observed that moderate hypoxia developed in some of the volunteers as a result of the eight-hour study. The vpO\u003csub\u003e2\u003c/sub\u003e. 2nd measurement in both single use three-ply surgical mask and N95 mask group was found to be low compared to vpO\u003csub\u003e2\u003c/sub\u003e-1st measurement at the end of eight hours. In relation, the vpO\u003csub\u003e2\u003c/sub\u003e values of the intensive care workers using two different types of masks were lower at the end of eight-hour period than the value at the beginning of the study. Studies evaluating blood gas analysis revealed a strong correlation between venous and arterial blood gas samples for pCO\u003csub\u003e2\u003c/sub\u003e, pH values, and a weak correlation for pO\u003csub\u003e2\u003c/sub\u003e and satO\u003csub\u003e2\u003c/sub\u003e values. They stated that venous blood gas can still provide information about respiratory functions [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite showing no change in vpCO\u003csub\u003e2\u003c/sub\u003e level in N95 mask group in the present study, vpCO2 was found to be significantly lower at the end of eight hours in workers using three-ply surgical masks. This result suggests that three-ply surgical masks may have allowed CO\u003csub\u003e2\u003c/sub\u003e leakage from the mask, and that those who use N95 masks may have re-breathed some of their exhailed air. Studies have shown that hypercarbia under mask initially developed during the adaptation process to the mask which is rapidly returned to normal levels. In the present study, this mechanism could be explained by the involvement of the compensatory respiratory dynamics [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Despite the pH values of the volunteers used both types of masks were found to be higher after eight hours, this difference was not considered clinically significant. Similar to the measured pH value, the decline in lactate level in N95 mask group was also not accepted as a clinically significant decrease.\u003c/p\u003e \u003cp\u003eFurthermore, Robberge et al. conducted a study on ten healthcare workers using filter mask for one hour, and they reported that carbon dioxide and oxygen levels were found to be reached significantly above the standards accepted for the workplace. They concluded that using a valve mask did not improve the pCO\u003csub\u003e2\u003c/sub\u003e level [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLi et al. reported that there was a decrease in tidal volume and some cardiopulmonary parameters in volunteers using surgical mask and no mask. They stated that the decrease in those parameters suggests that muscle mitochondria may reduce the ability to use oxygen thus affecting exercise capacity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBlood gas analysis revealed negative effects of long-term use of protective masks on the central nervous system, cardiovascular system and respiratory system [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The present study demonstrated that vpO\u003csub\u003e2\u003c/sub\u003e-2nd measurement in both mask groups was lower than the vpO\u003csub\u003e2\u003c/sub\u003e-1st measurement, and the presence of long-term intermittent low-level hypoxia had negative effects on cognitive and physical functions as reported in previous studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan additionalcitationids=\"CR11 CR12\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. In this study, volunteers declared cognitive dysfunction such as \u0026ldquo;I am forgetful\u0026rdquo;, \u0026ldquo;\u003cb\u003eI am having trouble on focusing\u003c/b\u003e\u0026rdquo;, \u0026ldquo;\u003cb\u003eI have distraction problem\u003c/b\u003e\u0026rdquo; ranged from 33.3\u0026ndash;54.8%. In addition, the rate of those who mentioned \u0026ldquo;I get tired quickly\u0026rdquo;, \u0026ldquo;I am nervous\u0026rdquo;, and \u0026ldquo;I am not as patient as before\u0026rdquo; was between 33.3% and 66.7%. Impairment in cognitive functions and negative behavioral changes were remarkable in intensive care workers. In this regard, Champod et al. found that intermittent hypoxia had a negative effect on learning and memory [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. It is known that the duration of mask use by healthcare workers was long and it continued recursively at varying intervals over time during COVID-19 pandemic. It has been stated in different studies that the possibility of developing intermittent and long-term hypoxia and hypercarbia could not be underestimated [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe most remarkable study among the studies conducted to date is the study of Vakharia et al. on sixty volunteers [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The authors conducted two groups, the three-ply mask and N95 mask group in which brain oxygenation was evaluated with cerebral blood oxygenation level dependent magnetic resonance imaging (BOLD MR) at the beginning of the shift and at the end of the six-hour shift. Headache was the most common symptom in both groups in their study. In addition, clinical symptoms such as nausea, vomiting, dizziness, blurred vision, drowsiness and fatigue were observed more frequently in N95 group, but also in the group using both types of masks [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn our study, it was observed that painkillers were used at a rate varying between 38.1% and 42.9% among all mask groups in healthcare workers compared to before during the pandemic. The pathophysiology of cerebral hypoxia is complex and multifactorial, and the severity and duration of hypoxia are important. In this context, hypoxia is defined under two headings as acute hypoxic hypoxia and chronic hypoxic hypoxia [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. A broad definition can be made for the duration of acute hypoxia and chronic hypoxia from seconds, hours, days and years. Cerebral vascular vessels respond with a change in vessel diameter when the pO\u003csub\u003e2\u003c/sub\u003e level decreases below 50 mmHg and in hypercapnia. Carbon dioxide is a potent vasodilator by leading to dilatation of the pial vessels, and a decrease in vascular resistance resulting an increase in cerebral blood flow (CCA). Vasodilation also occurs in the intracranial and extracranial arteries, carotid and vertebral arteries. In chronic hypoxia, blood is directed to vital centers in the brain stem. While cellular oxygenation is maintained, other non-vital brain regions remain relatively hypoxic [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eCerebral oxygenation is affected in the frontal lobe and anterior cingulate gyri. These regions manage the compensation mechanism for cognitive functions. The clinical mechanism of confusion was also explained in the study of Vakharia et al. by the demonstration of insufficient blood redistribution and compensation using BOLD MR in seven subjects[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. However, it is seen that there is still no consensus on what and how to use the definition of \"intermittent hypoxia\" [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. It has been stated that the effect of intermittent hypoxia on many organ systems is related to various variables (hypoxemia severity, hypoxia duration, number of cycles/day, intermittent hypoxia pattern-intermittent hypoxia-intermittent, consecutive days, total number of days) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWhen the neurophysiological basis of the effects of hypoxia on cognitive functions is examined, it has been reported that it causes some disorders ranging from metabolic homeostasis to the deterioration of neural integrity by causing molecular damage, depending on the severity of hypoxia. Cognitive functions such as attention, information storage, retrieval as well as processing speed are supported by many large-scale neural networks. The primary and sensory cortex with some of parietal and frontal regions join this network anteriorly. It has been shown that these regions are affected in hypoxic and ischemic memory disorders. It has been reported in various studies that there are regions of the brain that are sensitive to oxygen deficiency, especially those that are closely related to cognitive functions [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The effects of hypoxia on central nervous and cardiovascular system, and the cellular changes that have been shown to affect the mental state, may be sufficient to explain the response of the intensive care workers that we have observed in our study as \"I get tired more quickly\".\u003c/p\u003e \u003cp\u003eIn addition to these, it is not difficult to say that heavy working conditions may have an accumulated stress effect during the pandemic process. Mecit et al. showed an increase in burnout syndrome where anxiety and depression was observed during the pandemic process. Similarly in previous studies, the remarkable number of people those indicated that they were angry and not as patient as they used to be in the present study, supports the existence of psychological fluctuations ranging from anxiety to burnout syndrome during the pandemic [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThere are some limitations in the study. First, the number of patients and nationality is focused on one and small limiting the generatability of the findings of the present study. Second, arterial blood gas analysis might obtain detailed results compared to venous gas analysis however arterial access is an an invasive procedure thus restricting the feasibility of the procedure.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eImpairment in cognitive functions in intensive care workers using masks during the pandemic period can be explained by the development of intermittent long-term moderate hypoxia.. In addition, intensive care working conditions during the pandemic have been an important stress factor that also reveals somatic symptoms. It should also be noted that in the pre-vaccination period of the pandemic, when there are many unknowns, some of the healthcare professionals resort to much more conservative protective methods, such as the use of double masks. There is a need for comprehensive studies on the development of masks that offer more comfortable breathing.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthorcontributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHO: Conceptualization, Investigation, Methodology, Writing, Original Draft Preparation \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSD: Conceptualization, Analysis Investigation, Validatio Writing, Supervision\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eBA: Conceptualization, Investigation, Writing , Methodology, Writing, Supervision\u003c/p\u003e\n\u003cp\u003eHEE: \u0026nbsp;Formal Analysis Investigation,\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eProject Administrator: H O\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have not disclosed any funding.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIt wıll be present as an oral presentatıon ın TARK 2022 Congress\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethical committee of Mersin University Clinical Research Ethics Committee (Grant number: 23.03.2022/201)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInformed consent was obtained from all individual participants included in the study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003e\u003cspan\u003eSilva FCT, Barbosa CP. The impact of the COVID-19 pandemic in an intensive care unit (ICU): Psychiatric symptoms in healthcare professionals. Progress in Neuropsychopharmacology \u0026amp; Biological Psychiatry. 2021;299(110):1\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eScheid JL, Lupien SP, Ford GS, West SL 4. Commentary: Physiological and Psychological Impact of Face Mask Usage during the COVID-19 Pandemic: Int. J. Environ. Res. Public Health: 2020, 17, 6655; doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/ijerph17186655\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n \u003cli\u003e\u003cspan\u003eMecit BBT, Opak S, Yıldırım \u0026Ouml;D, Sıvacı RG. 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Adv Exp Med Biol. 2015;860:69\u0026ndash;80. doi:\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/978-3-319-18440-1_9\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Masks, Surgical attire, Coronavirus, Carbon Dioxide, Hypercapnia","lastPublishedDoi":"10.21203/rs.3.rs-2066014/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2066014/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eAim\u003c/h2\u003e \u003cp\u003eThe coronavirus disease-19 has caused the death of more than five million people and the treatment of millions in intensive care units since 2019. In this process, the possibility of developing intermittent, long-term hypoxia and hypercarbia due to the use of masks has been considered in detail. Therefore, the negative physiological and psychological effects of this equipment in intensive care unit by healthcare personnel have become questionable. The present study is aimed to investigate the effect of mask use on blood gas analysis values and cognitive functions in intensive care unit healthcare workers.\u003c/p\u003e\u003ch2\u003eMaterials and methods\u003c/h2\u003e \u003cp\u003e After obtaining local ethics committee approval (Grant number: \u0026hellip;) and written informed consent, healthcare professionals working in the 3rd level intensive care unit of xxx City Training and Research Hospital were included in the study. Each volunteer's venous blood gas analysis were studied at the beginning and end of the eight-hour morning-shift period. Venous blood gas values including pH, venous partial oxygen pressure, venous partial carbon dioxide pressure, lactate levels were recorded. A five-question survey was applied to the same volunteers and their cognitive function performance during the pandemic period was evaluated.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eIntragroup comparisons for the N95 group revealed that pH-2nd measurement was found to be significantly higher than pH-1st measurement and Lactate-1st measurement was significantly higher than Lactate-2nd measurement (p\u0026thinsp;=\u0026thinsp;0.002, p\u0026thinsp;=\u0026thinsp;0.004, p\u0026thinsp;=\u0026thinsp;0.002, p\u0026thinsp;=\u0026thinsp;0.018, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eImpairment in cognitive functions in intensive care workers using masks during the pandemic period can be explained by the development of intermittent long-term moderate hypoxia.\u003c/p\u003e","manuscriptTitle":"The effect of mask usage of the health personnel on blood gas analysis and cognitive strengthening during COVID-19 pandemic","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2022-09-19 21:03:35","doi":"10.21203/rs.3.rs-2066014/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c3f3dedd-c90f-4d7b-9b09-91b2c3ddf2d0","owner":[],"postedDate":"September 19th, 2022","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-03-27T05:45:51+00:00","versionOfRecord":{"articleIdentity":"rs-2066014","link":"https://doi.org/10.47391/JPMA.9243","journal":{"identity":"journal-of-the-pakistan-medical-association","isVorOnly":true,"title":"Journal of the Pakistan Medical Association"},"publishedOn":"2024-03-20 05:45:51","publishedOnDateReadable":"March 20th, 2024"},"versionCreatedAt":"2022-09-19 21:03:35","video":"","vorDoi":"10.47391/JPMA.9243","vorDoiUrl":"https://doi.org/10.47391/JPMA.9243","workflowStages":[]},"version":"v1","identity":"rs-2066014","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2066014","identity":"rs-2066014","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}