COVID-19

4:1 ratio enteral ketogenic formula within 48 hours of intubation

Ketogenic diet

standard of care

Severe Outcomes Among Patients with Coronavirus Disease 2019 (COVID-19) — United States, February 12-March 16, 2020

Keto-diet for Intubated Critical Care COVID-19

Keto-diet for Intubated Critical Care COVID-19 (KICC-COVID19)

PaCO2 is the partial pressure of carbon dioxide Units: millimeters of mercury

Minute ventilation is the product of respiratory rate and tidal volume. Units: Liter per minute

Respiratory system compliance measures the extent to which the lungs will expand.
In a ventilated patient, compliance can be measured by dividing the delivered tidal volume by the [plateau pressure minus the total peep]. Units: liter/centimeter of water

Driving pressure is a measure of the strain applied to the respiratory system and the risk of ventilator-induced lung injuries Driving pressure = Plateau pressure - Total Positive end-expiratory pressure (PEEP) Units: centimeter of water

Ventilator synchrony is the match between the patient's neural inspiratory time and the ventilator insufflation time

Mean arterial pressure is the average pressure in a patient's arteries during one cardiac cycle. Mean arterial pressure = diastolic blood pressure +[1/3(systolic blood pressure - diastolic blood pressure)] Units: millimeter of mercury

FiO2: Fraction of Inspired Oxygen Percentage of oxygen in the air mixture that is delivered to the patient.
Units: %

PaO2/FiO2 ratio is the ratio of arterial oxygen partial pressure (PaO2) to fractional inspired oxygen.
Units: millimeter of mercury

pH measures hydrogen ion activity. It is a conventional part of every arterial blood gas determination pH: no units.

Bicarbonate is a conventional part of every arterial blood gas determination Units: milliequivalents/Liter

Red blood cell count measure anemia or hypoglycemia. Units: cells per liter

White blood cell count evaluates leukopenia or leukocytosis. Units: cells/liter

White cell differential shows the amount of neutrophils, lymphocytes, basophils, eosinophils and may give some clue of the type of infection. Units: %

Hemoglobin is an indirect way to measure red blood cells. Units: gram/deciliter

Hematocrit measures the volume percentage of red blood cells in blood. Units: %

Mean cell volume is a measure of the average volume of a red blood corpuscle. Units: femtoliters

Mean cell hemoglobin is the average mass of hemoglobin per red blood cell in a sample of blood. Units: picograms

Mean cell hemoglobin concentration is the average concentration of hemoglobin in a given volume of blood. Units: %

Platelet count measures the number of platelets in the blood and determines thrombocytopenia or thrombocytosis. Units: platelets/liter

Red cell distribution width is a measure of the range of variation of red blood cell volume. Units: no units

Liver function test Units: gram/deciliter

Liver function test Units: international units/liter

Liver function test Units: international units/liters

Kidney function test Units: milligram/deciliter

Kidney function test Units: millimole/liter

Kidney function test Units: gram/deciliter

If the patient needs mechanical ventilation for a second time, this information will be collected.

Time from intensive care unit admission until death or transfer to hospital bed.

Time from hospital admission to discharge from the hospital. This information will be collected.

Once the patient feels better and can leave the hospital, he/she will be discharged. The place of discharge (e.g. home, rehab facility, nursing home, etc), time and date will be collected.

Heart rate: is the number of times a person's heart beats per minute

Glucose: sugar in blood. Units: millimole/liter

Glucagon: hormone release by pancreas that increase concentration of glucose in blood. Units: nanogram/liter

Free fatty acids are fatty acids that are produced from triglycerides and are measure in blood.

Hormone that regulates glucose. Units: insulin units/liter

Leptin helps regulate and alter long-term food intake and energy expenditure. Units: nanogram/deciliter

C-reactive protein is a protein made by the liver that measures inflammation (e.g. pancreatitis). Units: microgram/milliliter

Cytokines are signaling molecules that measure inflammation.

Ferritin stores iron inside of cells. Units: nanogram/milliliter

Johns Hopkins University

This is a single-center, open-label, clinical trial designed to determine whether a ketogenic diet improves gas exchange and reduces ventilator requirements in patients with coronavirus disease intubated for respiratory failure. The study team will prospectively enroll 15 intubated patients with COVID-19 infection and administer a 4:1 ratio enteral ketogenic formula within 48 hours of intubation. This study will compare outcomes to a retrospective cohort of intubated patients with COVID-19 who did not receive ketogenic diet. As other clinical trials begin, co-administration of other therapies as well as standard care treatments will be recorded. In addition, the study will compare clinical outcomes with patients receiving exclusively standard clinical care.

A respresentative population of 275 Liberian children with SAM and admitted to a CMAM/IMAM program supported by Action Against Hunger (75 of which have a MUAC < 115, 75 of which have a WHZ < -3 and 75 of which have both a MUAC < 115 mm and a WHZ < -3).

A respresentative population of 275 Burkinabé children with SAM and admitted to a CMAM/IMAM program supported by Action Against Hunger (75 of which have a MUAC < 115, 75 of which have a WHZ < -3 and 75 of which have both a MUAC < 115 mm and a WHZ < -3).

A respresentative population of 275 Bangladeshi children with SAM and admitted to a CMAM/IMAM program supported by Action Against Hunger (75 of which have a MUAC < 115, 75 of which have a WHZ < -3 and 75 of which have both a MUAC < 115 mm and a WHZ < -3).

Severe Acute Malnutrition

Action Against Hunger, Bangladesh

Action Contre la Faim, Burkina Faso

Action Against Hunger, Liberia

Biomedical Investigations for Optimized Diagnosis and Monitoring of Severe Acute Malnutrition (SAM): Elucidating the Heterogeneous Diagnosis of SAM by Current Anthropometric Criteria and Moving Beyond

OptiDiag: Biomedical Investigations for Optimized Diagnosis and Monitoring of Severe Acute Malnutrition (SAM): Elucidating the Heterogeneous Diagnosis of SAM by Current Anthropometric Criteria and Moving Beyond

Describe and compare the different types of SAM anthropometric diagnoses based on circulating leptin.

Describe and compare the different types of SAM anthropometric diagnoses based on Stable Isotope Analysis (SIA)

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs at admission; these include: dehydration, visible signs of wasting, pulse, signs of micronutrient deficiency, acute resipiratory infections, respiratory rate, temperature, dermatosis and hair changes and diarrhea.

Describe and compare the different types of SAM anthropometric diagnoses based on micronutrient status.

Describe and compare the different types of SAM anthropometric diagnoses based on bioelectric impedance (BI).

Describe and compare the different types of SAM anthropometric diagnoses based on the caretaker's perception of the patient's health and nutritional status.

Describe and compare the different types of SAM anthropometric diagnoses based on the history of lipid and protein catabolism (δ13C and δ15N isotopes in hair) reversed throughout nutritional rehabilitation.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs for dehydration at admission and the development of clinical signs of dehydration during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs of visible wasting at admission and the development of clinical signs of visible wasting during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of abnormal pulse at admission and the development of abnormal pulse during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs of micronutrient deficency at admission and the development of clinical signs of micronutrient deficency during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs of acute respiratory infection at admission and the development of clinical signs of acute respiratory infection during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of abnormal respiratory rate at admission and the development of clinical signs of abnormal respiratory rate during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of abnormal temperature at admission and the development of clinical signs of abnormal temperature during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs of dermatosis at admission and the development of clinical signs of dermatosis during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of clinical signs of hair change (color and consistency) linked to acute malnutrition at admission and the development of clinical signs of of hair change (color and consistency) during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on the severity of diarrhea at admission and the development of diarrhea during treatment.

Describe and compare the different types of SAM anthropometric diagnoses based on negative and positive treatment outcomes; these include: discharged from program as recovered [mid-upper arm circumference (MUAC) ≥ 125 and weight-for-height Z-score (WHZ) ≥ -2], defaulted from program (caretaker confirmation of unwillingness to participate), death, transfer to an in-patient facility (developement of medical complications as per national protocol, loss of or static weight), transfer to another out-patient facility outside of the program catchment area and facility and non-response to treatment (cure criteria unattained before maximum treatment duration).

Describe and compare the different types of SAM anthropometric diagnoses based on early weight gain.

Describe and compare the different types of SAM anthropometric diagnoses based on circulating leptin

Describe and compare the different types of SAM anthropometric diagnoses based on bioelectric impedance.

Measures of household wealth reflected by durable assets, source of water supply, sanitation favility, type of floor material, type of cooking fuel, transportation, livestock, homestead or land area, bank account, number of family members per sleeping room.

The HFIAS is composed of a set of nine questions that have been used in several countries and appear to distinguish food insecure from food secure households across different cultural contexts.

Individual dietary diversity scores (IDDS) validated for age/sex groups.

ketosis/fiebre

Keto-diet for Intubated Critical Care COVID-19

Biomedical Investigations for Optimized Diagnosis and Monitoring of Severe Acute Malnutrition (SAM): Elucidating the Heterogeneous Diagnosis of SAM by Current Anthropometric Criteria and Moving Beyond

Diagnosis of Ventilator- Associated Pneumonia in Children: A Comparative Study of Bronchoscopic and Non-Bronchoscopic Methods

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