Evidencia disponible sobre el abordaje terapéutico de pacientes con COVID-19: una revisión narrativa

Ronald E. Galdamez; Jorge L. Ranero; Dorian E. Ramírez

doi:10.36829/63CTS.v7i3.976

Autores/as

Ronald E. Galdamez Instituto Guatemalteco de Seguridad Social http://orcid.org/0000-0002-5911-3734
Jorge L. Ranero Instituto Guatemalteco de Seguridad Social http://orcid.org/0000-0002-7632-0102
Dorian E. Ramírez Universidad de San Carlos de Guatemala http://orcid.org/0000-0003-1952-2012

DOI:

https://doi.org/10.36829/63CTS.v7i3.976

Resumen

La ausencia de tratamiento específico para COVID-19 demanda una revisión dinámica de la evidencia científica disponible que permita un manejo dirigido a lograr la mejoría clínica, reducción de complicaciones y una menor mortalidad. Los factores independientes de riesgo asociados a mayor mortalidad, falla ventilatoria y necesidad de ventilación mecánica incluyen edad avanzada, enfermedades crónico-degenerativas, obesidad, elevación de ferritina, LDH, ALT y AST, marcadores de incremento en la generación de trombina, datos de daño cardiaco (elevación de troponinas y NT-pro-BNP) y niveles de IL-6 elevados. En ausencia de antivirales de acción directa, el abordaje terapéutico temprano con terapia anti-IL-6, la supresión de la cascada inflamatoria y transducción de señales mediante uso de glucocorticoides, la profilaxis trombótica y anticoagulación, así como la inhibición de la trombogénesis y noxa cardiaca con el uso de colchicina, pueden ser considerados hasta el momento como medidas plausibles en el manejo de los pacientes con COVID-19 en estado moderado y grave. Remdesivir puede considerarse para el tratamiento de pacientes con lesión pulmonar severa sin falla ventilatoria, tras evidencia sólida que ha demostrado mejoría clínica y reducción de mortalidad. En el subgrupo de pacientes graves y bajo ventilación mecánica, el uso de plasma de paciente convaleciente ha producido mejoría clínica, aunque la evidencia es limitada. La pronación en el paciente despierto y bajo ventilación mecánica puede considerarse como medida para mejorar la oxigenación con poca influencia sobre la mortalidad. Esta revisión plantea las medidas terapéuticas disponibles al momento y la estratificación de riesgo para el manejo de pacientes con infección por SARS-CoV-2.

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Biografía del autor/a

Ronald E. Galdamez, Instituto Guatemalteco de Seguridad Social

Jefe de Servicio de Infectología de Adultos, Instituto Guatemalteco de Seguridad Social

Jorge L. Ranero, Instituto Guatemalteco de Seguridad Social

Jefe de Servicio de Unidad de Cuidados Intensivos, Hospital General de Enfermedades

Dorian E. Ramírez, Universidad de San Carlos de Guatemala

Coordinador del Centro de Investigaciones de las Ciencias de la Salud, Facultad de Ciencias Médicas, USAC

Citas

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