Physiologic effects of surgical masking in children versus adults.

Background: Surgical masks remain a focal part of the CDC guidelines to decrease COVID-19 transmission. Evidence refuting significant effects of masking on ventilation is mostly limited to small studies, with a paucity of studies on children, and none comparing children to adults. Methods: A total of 119 subjects were enrolled (71 adults, 49 children) in a prospective interventional study with each subject serving as their own mask-free control. End tidal CO2 (ETCO2), inspired CO2 (ICO2), and respiratory rate were measured by nasal cannula attached to an anesthesia machine D-fend module. Pulse oximetry and heart rate were also followed. After the mask-free period, an ASTM Level 3 disposable surgical mask was donned and 15 min of mask-worn data were collected. Results: A steady state was confirmed for ETCO2 and ICO2 over the masked period, and mean ICO2 levels rose significantly (p < 0.001) after masking in all age groups. The increase in ICO2 for the 2- to 7-year-old group of 4.11 mmHg (3.23-4.99), was significantly higher (p < 0.001) than the final ΔICO2 levels for both the 7- to 14-year-old group, 2.45 mmHg (1.79-3.12), and adults, 1.47 mmHg (1.18-1.76). For the pediatric group there was a negative, significant correlation between age and ΔICO2, r = -0.49, p < 0.001. Masking resulted in a statistically significant (p < 0.01) rise in ETCO2 levels of 1.30 mmHg in adults and 1.36 mmHg in children. The final respective ETCO2 levels, 34.35 (33.55-35.15) and 35.07 (34.13-36.01), remained within normal limits. Pulse oximetry, heart rate, and respiratory rate were not significantly affected. Discussion: The physiology of mechanical dead space is discussed, including the inverse relationship of subject age vs ICO2. The methodology and results are compared to previously published studies which detracted from the physiologic safety of surgical masking. Conclusions: The wearing of a surgical mask results in a statistically significant rise in ICO2 and a smaller rise in ETCO2. Because ETCO2 and other variables remain well within normal limits, these changes are clinically insignificant.

Educating the Georgian Community on the Value and Benefits of Advanced Practice Nursing.

Advanced practice nurses are not currently recognized in Georgia, the country intersecting Eastern Europe and Western Asia. With a critical nursing shortage and the brain-drain of graduate nurses in Georgia seeking higher pay and more respect in other countries, it is an opportune time to examine the potential for advancing nursing practice through education and professional mentorship. The aim of the study was two-fold. The first goal was to educate the local community about the profession of advanced practice nurse anesthesia and the benefits of advanced practice nursing in Georgia through a certified registered nurse anesthetist-led education session designed for a cohort of undergraduate biochemistry students. Second, a qualitative analysis identified the current state of nursing practice and directed the next steps toward nursing advancement, regulation, professionalism, access to quality care, and globally acceptable standards of practice. An education session held at San Diego State University Tbilisi, although not statistically significant, was successful in improving public knowledge. Qualitatively, the study established extreme enthusiasm for developing a nurse anesthesia program, licensure, regulation, standards of care, continuing education, and quality. In a country eager to advance, certified registered nurse anesthetists have the distinct opportunity of supporting Georgia's movement toward westernized healthcare.