Adverse effects of COVID-protective face-masks and wearing durations onto respiratory-haemodynamic physiology and exhaled breath constituents
Abstract While protecting against the coronavirus transmission, face-masks may have adverse effects on respiratory-haemodynamic parameters. We investigated immediate and progressive effects of FFP2 and surgical masks on exhaled breath constituents and physiological attributes in 30 healthy volunteers at rest. We continuously monitored exhaled breath profiles in the mask space in elderly (age: 60–80 years) and adults (age: 20–60 years) over a period of 30 min by high-resolution real-time mass-spectrometry (PTR-ToF-MS). Peripheral oxygen saturation, respiratory- and haemodynamic parameters were measured (non-invasively) continuously in parallel. Profound and consistent decrease in SpO2 and increase in pET-CO2 indicates ascending deoxygenation and inadequate ventilation in subjects. Cardiac output and MAP changed as secondary. Exhalation of blood-borne volatile metabolites mirrored behaviour of cardiac output, MAP, SpO2, respiratory rate and pET-CO2. FFP2 masks affected more pronouncedly than surgical masks. Elderly cohort was more vulnerable to those effects. Exhaled humidity increased and exhaled oxygen decreased significantly over time. Breath profiles of endogenous aldehydes, hemiterpene, organosulfur, short-chain fatty acids, alcohols and ketone indicated cross-talks between physio-metabolic effects such as hypoxia, oxidative stress, hypoventilation, compartmental vasoconstriction, altered systemic bacterial activity and energy homeostasis. Concentrations of exogenous VOCs such as aromatics, nitrile and monoterpene depicted compartmental storage and washout. Breathomics allows unique physio-metabolic insights into side effects of face-mask wearing. Mask induced deoxygenation, oxidative stress, CO2 rebreathing, vasoconstriction and blood pressure fluctuations in elderly were clinically concerning (as leading towards hypoxia and hypoventilation). Intelligible global-pandemic policies should reconsider the type and wearing durations of recommended face-masks, based upon age and/or cardio-pulmonary conditions.