PONE-D-21-12993

Cost-effectiveness of the TherMax Blood Warmer During Continuous Renal Replacement Therapy

PLOS ONE

Dear Dr. Blackowicz,

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PLOS ONE

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Additional Editor Comments:

Tx for your contribution. As stated by the reviewer the paper needs major revision

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Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: The authors described a novel device to reduce risk of hypothermia during CRRT, the topic is interesting in the ICU setting, perhaps the manuscript needs major revision and the conclusions are not completely supported by data.

Major revision:

- Please move the definition of hypothermia in the methods.

- Please describe in the methods how data transfer has been made.

- Is there any chance to record the temperature every minute? Did the authors consider in the analysis a single value recorded or at least an hour of hypothermia?

- Page 4 lines 90-91: The authors mentioned as inclusion criteria CRRT for at least 1 hour, I think the duration of the treatment is too short to affect the outcome, please discuss about that.

-Please provide the mean duration of the CRRT in the 2 groups.

- Page 5, line 98: Recording temperature from different sites could be a limit of the study, please discuss about that.

- Table 1: Please write the exact p value instead of “not significant” or “p<0.05”.

- Table 1: Number of treatments in the 2 groups are not in accordance with the text, in the table are 310 vs 32, in the manuscript the authors mentioned 526 patients treated with CRRT, it’s difficult for me to understand.

- Table 1: The comparison between 310 and 32 treatments could be a statistical issue.

- In the introduction the authors described the potential complications of the hypothermia, such as arrhythmia, coagulopathy, but they did not mention kind and rate of complications in the study.

- Page 11: It’s difficult for me to understand this limit “the current data was obtained over 10 months”, the authors wrote in the methods that they included patients between 2006 and 2020, please clarify.

- In the conclusion: the statement “TherMax reduced the risk of mortality associated with hypothermia” is not supported by data, in table 2 I can see the same mortality for hypothermia in both groups 59.2% and I think it’s quite hard to assume that the mortality is due to hypothermia, please make a comment.

Minor revision:

- Please type “TherMax” in the same way in the manuscript (“Thermax” vs “TherMax”).

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Reviewer #1: Yes: Camilla L'Acqua

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Cost-effectiveness of the TherMax blood warmer during continuous renal replacement therapy

PONE-D-21-12993R1

Dear Dr. Blackowicz,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org.

Kind regards,

Andrea Ballotta

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Thank you again for your contribution and i apologize for the delay. On the basis of the reviewer's comments i deem the paper suitable for publication.

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

**********

4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No