Home Health Study shows FFP2/3 respirators may increase risk of respiratory complications in COVID...

Study shows FFP2/3 respirators may increase risk of respiratory complications in COVID patients

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Personal protective equipment (PPE) was rarely in the news during the peak of the COVID-19 pandemic. However, new research published in Anesthesia shows that the anesthesiologist’s use of filtering facepieces (FFP) of 2 or 3 respirators is associated with a 38% increased risk of airway complications in the patient.

The study was carried out by Dr Karim El-Baghdadli, Consultant in Anesthesia and Post-operative Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK, and colleagues from the AeroComp Trainee Research Networks.

This association between FFP2/3 use and airway complications was found to be largely due to the association between FFP2/3 use and a 68% increased risk of a patient being heavily ventilated (patients receiving mask ventilation before being fitted breathing tube inserted); and FFP2/3 use was also associated with a 2.4-fold increased risk of a patient’s blood oxygen readings falling to dangerously low values ​​(desaturation) as measured by pulse oximeters.

The perceived risk of transmission of aerosolized viral particles from patients to respiratory professionals during the COVID-19 pandemic has led to widespread use of aerosolized precautions, including personal protective equipment and modification of anesthesia techniques. The risk of these increased aerosol precautions to patients during anesthesia and surgery, including airway complications, had not been evaluated outside of modeling studies before this new study.

To further investigate, the authors conducted this prospective, national, multicenter cohort study that enrolled adult patients undergoing general anesthesia for elective or emergency procedures within a 96-hour period. Data collected included use of aerosol precautions (various personal protective equipment, including FFP2/3 worn by anesthesiologists), airway complications, and potential confounding variables.

Data from 5,905 patients from 70 hospitals were included, and results were adjusted for patient body mass index (BMI), SARS-CoV-2 status, surgical urgency, and degree of first person intubation. The rate of respiratory tract complications was 10%. While the above associations were noted with FFP respirator use and airway complications, difficult ventilation, and facemask desaturation, no association with airway complications was noted with the use of goggles, air-purifying respirators, long-sleeved gowns, double gloves or video laryngoscopy.

In discussing potential reasons for the association between FFP2/3 use and respiratory complications, the authors note that modeling studies report user discomfort when wearing respirators due to heat, as well as impaired speech intelligibility by the wearer.

The authors say: “Overall, the use of 2 or 3 respirator masks was associated with an increased risk of respiratory complications, but most aerosol precautions used during the COVID-19 pandemic were not… Further research is needed to establish a causal relationship between use of FFP2 or 3 respirators and respiratory complications”.


Mask ventilation of patients during surgery does not increase the risk of spreading COVID-19


Additional information:
Aerosol Precautions and Respiratory Complications: A National Prospective Multicenter Cohort Study, Anesthesia (2022).

Courtesy of AAGBI

Citation: Study shows FFP2/3 respirators may increase risk of respiratory complications in COVID patients (September 7, 2022) Retrieved September 7, 2022, from https://medicalxpress.com/news/2022-09-ffp23-respirators -airway-complications-covid .html

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