The influence of N95 and surgical masks on carbon dioxide levels: A comprehensive systematic review and meta-analysis.

OBJECTIVES

This study aimed to assess the impact of wearing N95 and surgical masks on carbon dioxide (CO) concentrations during various activity levels, to understand the implications for mask use in different settings, especially in light of the COVID-19 pandemic.

STUDY DESIGN

Systematic Review and Meta-Analysis.

METHODS

A systematic review was conducted, retrieving 6798 articles from PubMed, Web of Science, and Scopus databases. Twenty-nine articles met the inclusion criteria. Mask types were categorized into N95 and surgical masks, while activities were classified as low, medium, and high.

RESULTS

The meta-analysis revealed CO concentrations (mmHg) for different scenarios: No mask (37.91, 95 % CI: 36.46, 39.35), N95-low (36.83, 95 % CI: 33.57, 40.10), N95-moderate (37.85, 95 % CI: 36.51, 39.20), N95-high (39.51, 95 % CI: 38.00, 41.02), N95 with exhalation valve (35.82, 95 % CI: 32.89, 38.75), N95 without exhalation valve (38.45, 95 % CI: 37.10, 39.81), surgical mask-low (38.31, 95 % CI: 34.48, 42.14), surgical mask-moderate (35.05, 95 % CI: 31.12, 38.97), surgical mask-high (36.07, 95 % CI: 34.18, 37.96).

CONCLUSIONS

Our findings indicate that N95 masks lead to higher CO accumulation during various activities compared to surgical masks. Moreover, surgical masks exhibit higher CO concentrations during low activity compared to moderate and high activities. Notably, CO concentrations are higher in N95 masks without an exhalation valve compared to those with a valve. No significant difference was observed between not wearing a mask and wearing either N95 or surgical masks in terms of CO accumulation. These results provide important insights for mask selection and usage recommendations in different scenarios.