PONE-D-22-04075Characteristics of postintubation dysphagia in ICU patients in the context of the COVID-19 outbreak: A report of 920 cases from a Brazilian reference centerPLOS ONE

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Reviewers' comments:

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Comments to the Author

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Reviewer #1: Partly

Reviewer #2: Yes

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

Reviewer #1: I Don't Know

Reviewer #2: I Don't Know

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Reviewer #1: Yes

Reviewer #2: Yes

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Reviewer #1: Yes

Reviewer #2: Yes

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5. Review Comments to the Author

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Reviewer #1: Authors realized, and proposed for publication, a monocentric prospective observational cohort study to determine risk factors of swallowing dysfunction in COVID 19 patients who required prolonged mechanical ventilation. We thank them for this work.

General remarks:

Authors realized a significant work in view of the number of patients included, but restricting ourselves to patients with COVID 19 raises the question of the external validity of the results. This work also confirms the possibility of relying on a method of clinical evaluation of swallowing.

Detailed comments:

Introduction :

P5, l 77-78: another recent reference can be reported (https://doi.org/10.1186/s13613-020-00752-x); this also opening the discussion to be carried out on the definition of an extended duration of mechanical ventilation.

P6, l 86-88 : lacks a reference comparing COVID 19 and non-COVID 19 patients; or specify that such a reference does not exist.

Methods :

Specify how many beds are available in the dedicated unit.

P7 l 108 : why this extremely questionable choice of 48 hours to define a prolonged orotracheal intubation? Showing the results with other limits seems essential.

Results:

On what criteria are the only 20% of patients eligible for this swallowing evaluation chosen? This is a crucial point.

Many results, of unequal interest. Simplify the presentation. Those of table 3 could be proposed in appendix.

Table 4: it is unclear to what clinical situation these results correspond

Discussion :

To be reviewed once the presentation of the results has been revised and simplified. The discussion will then have to be shortened.

So authors propose us an interesting monocentric prospective observational study, which need important modification before hoping for publication.

Reviewer #2: Many thanks for the opportunity to act as a reviewer of this work. Congratulations, the work is well written and covers the important part of our practice these days. Several comments:

-- I am missing more structured description of the swallowing management.

-- Why do you think there is such a large significant difference between the groups for the presence of commorbidities such as kidney diseases or high blood pressure. Please explain in the discussion.

-- The presence of tracheostomy plays a crucial role in dysphagia. Would you consider it to be factor for bad prognostic outcome in your study?

Many thanks.

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Reviewer #1: No

Reviewer #2: No

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Characteristics of postintubation dysphagia in ICU patients in the context of the COVID-19 outbreak: A report of 920 cases from a Brazilian reference center

PONE-D-22-04075R1

Dear Dr. de Andrade,

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.

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Kind regards,

Chiara Lazzeri

Academic Editor

PLOS ONE

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