Telemedicina en pacientes COVID-19

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Durante la pandemia de COVID-19, nuestro servicio de Telesalud, en una Clínica privada de la Patagonia Argentina, implementó un modelo de atención exclusivo para pacientes con coronavirus, asintomáticos o con sintomatología leve, ambulatorios con el cual se realizó seguimiento diario hasta cumplir 10 días de aislamiento y monitoreo. A los pacientes se les entrego un kit de monitoreo domiciliario con un saturómetro, un tensiómetro y un termómetro; además se les enseño a tomar frecuencia respiratoria y se les instruyo en pautas y signos de alarma. Todos los días se realizó una videollamada con chequeo de signos vitales y seguimiento clínico de evolución de síntomas.

Con más de 400 pacientes bajo este protocolo se detectaron tempranamente complicaciones subclínicas, ya que ante la alteración de la curva evolutiva de síntomas y signos, los pacientes fueron referidos a la unidad de atención para pacientes COVID-19 de la Clínica en donde se realizaron estudios de laboratorio e imágenes con Rx y AngioTac multislide, lo que permitió confirmar los diagnósticos presuntivos.

En ningún caso la derivación al centro de atención fue en vano.  Algo más del 15% de los pacientes requirieron internación por diferentes cuadros, entre los más frecuentes encontramos Tromboembolismo de Pulmón, la mayoría subsegmentarios bilaterales, con requerimientos de anticoagulación con enoxaparina por 5 días y luego 6 meses con rivaroxaban,  y compromiso parenquimatoso pulmonar que obligo cubrir infecciones bacterianas sobreagregadas oportunistas. Uno de los signos de alarma más eficaz resulto ser la presencia de desaturacion y taquicardia desmedida a mínimos esfuerzos.  Muchos pacientes, sobre todo los jóvenes y sin antecedentes patológicos relevantes, subestiman los síntomas y signos, por lo cual requieren de un seguimiento exhaustivo, y las personas mayores presentan agudización súbita de los cuadros.

Sin duda el seguimiento vía Telemedicina se transformó en una herramienta protagónica para los pacientes COVID-19, ya que se insertó en un modelo de atención integral siendo uno de los eslabones más relevantes para la detección precoz de complicaciones potencialmente fatales. La comunicación telefónica no es recomendable, subestima los cuadros y suelen ser comunicaciones más breves y distantes.  La videollamada permite ver la fascie del paciente, su mecánica respiratoria, su semblante y resulta fundamental aportando muchísimos datos al seguimiento del paciente. La pandemia aún no termina, y la Telemedicina ya está consolidada para la atención de estos pacientes y muchos otros cuadros también.

Dr. Ramiro Vaca Narvaja

Coordinador del Departamento de Telesalud en la Clínica Pasteur Neuquen, Argentina. Co-fundador y Director Médico T-MAIDER.

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