COVID-19 symptoms at hospital admission vary with age and sex: results from the ISARIC prospective multinational observational study

Background: The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods: International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruited from 43 countries between 30 January and 3 August 2020. Logistic regression was performed to evaluate relationships of age and sex to published COVID-19 case definitions and the most commonly reported symptoms. Results: ‘Typical’ symptoms of fever (69%), cough (68%) and shortness of breath (66%) were the most commonly reported. 92% of patients experienced at least one of these. Prevalence of typical symptoms was greatest in 30- to 60-year-olds (respectively 80, 79, 69%; at least one 95%). They were reported less frequently in children (≤ 18 years: 69, 48, 23; 85%), older adults (≥ 70 years: 61, 62, 65; 90%), and women (66, 66, 64; 90%; vs. men 71, 70, 67; 93%, each P < 0.001). The most common atypical presentations under 60 years of age were nausea and vomiting and abdominal pain, and over 60 years was confusion. Regression models showed significant differences in symptoms with sex, age and country. Interpretation: This international collaboration has allowed us to report reliable symptom data from the largest cohort of patients admitted to hospital with COVID-19. Adults over 60 and children admitted to hospital with COVID-19 are less likely to present with typical symptoms. Nausea and vomiting are common atypical presentations under 30 years. Confusion is a frequent atypical presentation of COVID-19 in adults over 60 years. Women are less likely to experience typical symptoms than men

ECCO2R case study

Hypercapnic respiratory failure is common in ICU due to ARDS and COPD exacerbations. The use of ECCO2R has changed the way we manage these patients. We report a patient with COPD exacerbation that failed NIV and placed on low flow ECCO2R. Low flow ECCO2R does not support oxygenation and only clears a proportion of the CO2 produced.Presentation of the case: a 64 y old women with severe COPD who failed NIV was placed on ECCO2R with the Hemolung system. The severe respiratory acidosis cleared and intubation was avoided. After a few days, she became more hypoxic, and the decision was made not to intubate this patient.There is increased CO2 production and decreased clearance of CO2 during COPD exacerbation. ECCO2R has been shown to improve mortality and decrease the need for intubation. There are various ECCO2R systems on the market with different flows and differently sized oxygenators.The use of ECCO2R in selected patients is a promising add-on to conventional management of these patients. The difficulty in predicting the progression of the disease will always be a challenge. Extracorporeal therapies should be performed in centres that are experienced in the management of these patients. Keywords: ECCO2R, Acute respiratory failure, Chronic obstructive pulmonary diseas

Physiotherapy for ECMO patients

Physiotherapy is part of the overall care in an interdisciplinary intensive care unit. Patients on extracorporeal membrane oxygenation (ECMO) were previously deemed to be too unstable to mobilise. Safety is of paramount importance as these patients often have multiple large cannulas, monitoring and lines. Mobilisation protocols should be in place, and each team member must be aware of their role. Contra-indications for mobilisation should be adhered to, and patients should be monitored before, during and after mobilisation. Secretion and respiratory management should be performed daily to address the reason why the patient was placed on ECMO. Keywords: Physiotherapy, Extracorporeal membrane oxygenation, Intensive care, Mobilisatio

The use of CRRT in ECMO patients

Extracorporeal life support (ECLS) is an effective therapy used for patients who are severely hypoxic as well as those with cardiogenic shock. Many of these patients require continuous renal replacement therapy (CRRT) as they are too unstable for intermittent haemodialysis. Prognosis of patients who are on ECMO tends to do worse if they develop acute renal failure during the ECMO run resulting in the requirement for dialysis. According to the ELSO registry, the mortality of patients requiring renal replacement therapy (RRT) on ECLS is increased. There are various ways to connect a CRRT circuit onto an ECMO circuit. Each method has its advantages and disadvantages. Separate access for CRRT is recommended. Keywords: ECMO, Continuous renal replacement therapy, Acute kidney injur

The value of open-source clinical science in pandemic response: lessons from ISARIC

International audienc

ISARIC-COVID-19 dataset: A Prospective, Standardized, Global Dataset of Patients Hospitalized with COVID-19

The International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC) COVID-19 dataset is one of the largest international databases of prospectively collected clinical data on people hospitalized with COVID-19. This dataset was compiled during the COVID-19 pandemic by a network of hospitals that collect data using the ISARIC-World Health Organization Clinical Characterization Protocol and data tools. The database includes data from more than 705,000 patients, collected in more than 60 countries and 1,500 centres worldwide. Patient data are available from acute hospital admissions with COVID-19 and outpatient follow-ups. The data include signs and symptoms, pre-existing comorbidities, vital signs, chronic and acute treatments, complications, dates of hospitalization and discharge, mortality, viral strains, vaccination status, and other data. Here, we present the dataset characteristics, explain its architecture and how to gain access, and provide tools to facilitate its use