COVID-19 and Marfan/VEDS/LDS: Your Questions Answered
48:38-52:07
"If we need to be in the hospital or on a ventilator, do we need higher or lower ventilator pressures?"
「病院で人工呼吸器を使うことになったら、人工呼吸器の圧力は高いほうがいいのか、低いほうがいいのか？」というご質問ですね。
You know, that's gonna vary from individual to individual. An intensive care doctor or a pulmonologist is going to be adjusting the settings of the ventilator to achieve the goal of having enough oxygen absorbed into the body, so, you know, the right answer is that they're going to be using the ventilator settings that, that individual requires to have them receive the appropriate level of support.
これについての回答は、患者さん一人ひとりに応じて異なります。集中治療室の医師、あるいは呼吸器専門医が、十分な量の酸素が吸収されるよう、人工呼吸器を調整します。ですから、正しい回答としては、個々の患者さんに適した設定ということになります。
There's no one right answer; as the disease progresses and increases in severity, ventilator settings might in general will need to go up. As someone recovers, ventilator settings will go down that will not be based upon underlying connective tissue diagnosis but rather will be based upon the individual needs of that person in order to get oxygen into the body, so in general, same management principles apply for people with connective tissue disorders as anyone else.
正解は唯一つではありません。病気が進行し重症化すれば、一般的に人工呼吸器の圧力の設定は高くなるでしょう。病気が快方に向かえば、圧力の設定値は低くなると考えられます。これは結合組織疾患があるからというわけではなく、個人個人の必要な酸素量によって決まります。結合組織疾患の方でも同じ原則が適用されます。
The only thing that I would add to what Hal said is he's perfect and I think we all forget that Hal was a pediatric intensivist and has trading as anesthesiologist, actually also in addition to all of his other kind of incredible skills.
私の方から一つだけ追加します。Dietz先生は素晴らしい方です。先生は小児科の集中治療医をされていましたし、様々なスキルの他に麻酔科医という肩書もお持ちです。
And one thing that we're finding in the COVID patients is that their lungs are not scarring, that in previous situations with severe viral pneumonias, the lungs that are much more susceptible to these pneumonias, become very scarred and very stiff and that's often why they require very, very high ventilator pressure in order to expand them.
さて、私達がCOVID-19の患者さんを診察してわかったことは、肺の損傷はみられないということです。これまで重度のウイルス性肺炎の症例を複数経験しましたが、肺はひどく損傷し、非常に固くなっていましたので、肺を膨らませるために人工呼吸器の圧力を非常に高くする必要がありました。
It turns out that with COVID that's not the case, that the lungs are not scarring and but the lungs are not able to transfer oxygen very efficiently to the bloodstream, so the ventilator settings are largely dictated to optimize oxygen delivery and the lungs are fairly compliant. That's a good thing.
COVID-19ではそのような所見はなく、肺は損傷していないのですが、酸素をうまく血流に送り込むことができなくなっています。酸素をうまく供給できるよう人工呼吸器の設定を最適化すれば、肺は十分適応します。これは良いことです。
What I don't know is whether if you add on to that a diagnosis of a connective tissue disorder, whether the lungs become even more compliant and may need kind of even less kind of ventilator pressure in order to expand, so that's one of the considerations that we have to think about and when we get more data on patients who may require some type of respiratory support and have these underlying conditions, we'll know better as to what types of adjustments need to be made.
わかっていないのは、COVID-19と結合組織疾患を合併した場合です。肺がより適応しやすくなるのか、人工呼吸器の設定値を下げる必要があるのか等がわかっておらず検討が必要ですが、呼吸器サポートが必要で、マルファンのような基礎疾患のある方のデータが集まれば、対処法が見えてくると思います。
The Marfan Foundation did not participate in the translation of these materials and does not in any way endorse them. If you are interested in this topic, please refer to our website, Marfan.org, for materials approved by our Professional Advisory Board.
The Marfan Foundation は、当翻訳には関与しておらず、翻訳内容に関してはいかなる承認も行っておりません。このトピックに興味をお持ちの方は、Marfan.org にアクセスし、当協会の専門家から成る諮問委員会が承認した内容をご参照ください。
