In a recent study published in Environmental Research, researchers investigated whether surgical and N95 masks cause respiratory problems in children.
Study: Respiratory function in children wearing masks. Image credit: BearFotos/Shutterstock
background
In a recent paper published by Walach et al., they stated that the use of face masks in children increased the amount of carbon dioxide (CO2) in the inhaled air so rapidly to a high level that even in conditions of rest would entail serious health risks. The authors of the current work noted several methodological limitations of Walach et al. study so that parents do not consider masking harmful and dangerous for their children.
Wallach et al. considers 2000 parts per million (ppm) CO2 levels as the cut-off value for CO2 toxicity. This value applies to indoor air quality, while the environment created between the face and the mask is not comparable to a closed environment. Also, according to the US Centers for Disease Control and Prevention (CDC) website, exposure to about 50,000 ppm of CO2 for 30 minutes causes the first symptoms related to respiratory distress. Wallach et al. reported CO2 levels between 13,120 and 13,910 ppm, which are well below the threshold for CO2 toxicity.
Second, Walach et al. The study couldn’t prove the supposed link with hypercapnia because they couldn’t measure blood CO2 levels. The main physiological compensation mechanism for hypercapnia is the increase in respiratory and heart rate. The study subjects did not show these symptoms and did not show a decrease in oxygen saturation (SaO2). Finally, the measurement device used by Walach et al. in his study he could not adjust for the rate of change of CO2, thus giving unreliable results.
About the study
In the present study, researchers assessed respiratory distress in children using multiple parameters, including end-stage partial pressure of carbon dioxide (PETCO2), heart rate, respiratory rate, and clinical signs. They monitored changes in respiratory parameters in all study subjects every 15 minutes. For the first 30 minutes, these children did not wear a mask, but were asked to do so later. The masking sessions consisted of a 12-min walking test in a 40-m-long corridor.
Results and conclusion
During rest and physical activity, the use of a surgical mask did not cause significant changes in the respiratory parameters of the children. N95 mask use, especially during physical activity, increased PETCO2 but remained in the normal range. Overall, none of the children evaluated in the current study showed any clinical signs of respiratory distress throughout the duration. In support of these findings, another recent study in adults with severe lung failure showed that surgical masks did not influence their gas exchange abilities.
In addition, several studies have demonstrated the efficacy and accuracy of methods involving assessment of PETCO2 to show changes in parameters of respiratory distress, including venous pCO2 and arterial pCO2. The implications of mask use in pediatric age require careful consideration because it is the only non-pharmaceutical intervention measure that could reduce the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In addition, it could help contain many common pediatric diseases, which, in turn, could reduce health care system costs.
Most importantly, there is enough clinical evidence to support the safety of masks in the pediatric age. Thus, parents should not doubt that the use of masks is dangerous for their children or increases the carbon dioxide in the inhaled air. In fact, it prevents the spread of multiple pathogenic infections, including SARS-CoV-2, for the sake of public health.