Plasmaféresis como opción terapéutica en infección por COVID-19
2020
espanolIntroduccion: El COVID-19, es una neumonia ocasionada por el nuevo coronavirus SARS-CoV-2, que se puede presentar con cuadros severos, distres respiratorio agudo (SDRA), disfuncion organica multiple y muerte; como consecuencia de una respuesta inflamatoria alterada denominada “tormenta de citoquinas”. La plasmaferesis se propone como una estrategia de tratamiento prometedora para el manejo de este tipo de complicaciones. Objetivo: nuestro objetivo principal es mostrar toda la bibliografia disponible, referente a la utilidad de la plasmaferesis en el manejo de la tormenta de citoquinas en pacientes con COVID-19 grave; evaluar su posible beneficio y proponer realizar nuevos ensayos clinicos que avalen el uso rutinario de esta terapia. Metodologia: Se realizo una busqueda avanzada con los terminos DeSC “Infecciones por Coronavirus; SARS-CoV; Plasmaferesis; Recambio plasmatico; Disfuncion organica multiple; Sepsis; Sindrome de respuesta inflamatoria sistemica; Lesion renal aguda”. A traves de los motores de busqueda Clinical Key, Embase, PubMed y Ovid, obteniendo un total de 156 resultados, entre articulos originales, reportes de casos, series de casos y revisiones de la literatura, se seleccionaron un total de 54 articulos que fueron utilizados para la elaboracion de la presente revision de la literatura. Conclusiones: La terapia de recambio plasmatico se podria utilizar como tratamiento complementario, con el objetivo de reducir carga inflamatoria y viral, reduciendo asi el dano de organo blanco. Sin embargo, hace falta la realizacion de ensayos clinicos controlados y con buenos disenos metodologicos, que nos ayuden a demostrar la efectividad de este tipo de terapias en pacientes con COVID-19 grave. EnglishIntroduction: COVID-19 is a pneumonia caused by the new SARS-CoV-2 coronavirus, which can present with severe symptoms, acute respiratory distress (ARDS), multiple organ dysfunction and death; as a consequence of a dysregulated inflammatory response called “cytokine storm”. Plasmapheresis is proposed as a promising treatment strategy for the management of this type of complications. Objective: our main objective is to show all the available bibliography, referring to the utility of plasmapheresis in the management of cytokine storm in patients with severe COVID-19; evaluate its possible benefit and propose new clinical trials to support the routine use of this therapy. Methodology: An advanced search was performed with the DeSC terms “Coronavirus Infections; SARS-CoV; Plasmapheresis; Plasma exchange; Multiple organic dysfunction; Sepsis; Systemic inflammatory response syndrome; Acute kidney injury ”. Through the search engines Clinical Key, Embase, PubMed and Ovid, obtaining a total of 156 results, among original articles, case reports, case series and literature reviews, a total of 54 articles were selected and used for the preparation of this literature review. Conclusions: Plasma replacement therapy could be used as a complementary treatment, with the aim of reducing inflammatory and viral loads, thus reducing target organ damage. However, it is necessary to carry out controlled clinical trials with good methodological designs that help us demonstrate the effectiveness of this type of therapy in patients with severe COVID-19.
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