Mechanical ventilation for COVID-19: Outcomes following discharge from inpatient treatment

Mark J. Butler; Jennie H. Best; Shalini V. Mohan; Jennifer A. Jonas; Lindsay Arader; Jackson Yeh

doi:10.1371/journal.pone.0277498

Peer Review History

Original SubmissionMay 20, 2022
6 Jul 2022 Decision Letter - Masaki Tago, Editor PONE-D-22-12638Mechanical Ventilation for COVID-19: Outcomes Following Discharge from Inpatient TreatmentPLOS ONE Dear Dr. Butler, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. This manuscript was peer-reviewed by three reviewers. Although the analysis methodology and the presentation of the result do not seem to have major problems, the reviewers have mentioned some major concerns in this manuscript regarding the scientific significance of this study, the interpretation and discussion of the results, and the data collection methodology. Therefore, the authors need to respond to all reviewers' comments. Especially please clarify the purpose and scientific significance in the introduction and the conclusions that can be drawn from the results of this study so that readers can understand them. Please submit your revised manuscript by Aug 20 2022 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. 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Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols. We look forward to receiving your revised manuscript. Kind regards, Masaki Tago, M.D., Ph.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. 3. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] 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 Reviewer #2: Yes Reviewer #3: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ****** 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: No Reviewer #2: Yes Reviewer #3: Yes ****** 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 Reviewer #2: Yes Reviewer #3: Yes ****** 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: Thank you for submitting your research article entitled “Mechanical ventilation for COVID-19: outcomes following discharge from inpatient treatment”. Authors evaluated the long-term outcomes of severe COVID-19 patients with or without mechanical ventilation (MV), its impacts on the hospital readmission, all-cause mortality, and reason for readmission. I think this manuscript is very meaningful for all medical personnel who are involved in COVID-19 pandemic. However, there are some major concerns that should be addressed by the authors at this time. <major comments=""> 1. First of all, I think the topic of this study have little impact for the readers of this journal so that authors have not fully discussed in the DISCUSSION section. It is easy to imagine that the clinical prognosis of cases requiring mechanical ventilation is poor not only for other infections but also for COVID-19. Are there any differences in the characteristics or prognostic tendencies peculiar to patients with COVID-19? 2. In the INTRODUCTION section, authors described that MV can produce lung injury, which lead to poor long-term outcomes in this condition. Among the present study populations, authors should discuss whether these poor outcomes and high readmission rates are due to the effects of mechanical ventilation management, the complications of COVID-19, or other factors? 3. Authors described the limitation of data sampling in terms of readmission rate. Although I am not sure how many patients’ readmissions this healthcare system (Northwell Health) can cover, this limitation should be fully discussed since readmission rate is a primary outcome in this study. I would like to know how far the readmission ate in this study is from the real-world readmission rate. 4. Are there any standardized manual for MV management in these 23 medical facilities? If not, how did the physicians decide the indication of MV? Did you employ high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NPPV)? Moreover, are there any relationships between the duration of the intubation and readmission rate? 5. In the CONCLUSIONS, second paragraph [P15L11-P16L2] is not based on the data of this research. This is not conclusion of this study. <minor comments=""> 1. [P5L18] January 31, 2020 -> January 31, 2021 2. There are no “Table 1”, ”Table2” and “Table 3”. 3. For propensity score matching, please list the factors in order to make the adjustments.</minor></major> Reviewer #2: Butler et al. reported the outcome of COVID-19 patients following discharge differentiating between those who needed mechanical ventilation and those without it. As expected, patients who required MV were more susceptible to readmission and lower survival. The authors state that this feature is clearly recognized in ordinary ICU patients (not COVID), so the objective of this study should be clarified. Was their hypothesis that COVID patients behave differently (better or worse) than ordinary ICU patients? Then, the readers should be informed about how different the present results are compared with series of non-COVID patients. Nevertheless, even these comparisons are tricky because non-COVID severe ARF commonly affect patients with severe sepsis or severe comorbidities that explained most of the long-term outcome worsening. Additional comments: 1.- Page 15, conclusions should be tailored by deleting the first 3 lines: “MV is an essential treatment ……... important”. Also, the second paragraph about possible solutions must be moved to the end of the discussion section. Reviewer #3: This is a very well done and well written study. I have a few minor corrections. 1. When the patient gets readmitted and is assigned the ICD category code of COVID 19 - does that mean he's got a re-infection, is PCR positive or has just recovered from COVID-19? It would be nice if there is one line to elaborate what that ICD code includes. (Page 7) 2. In page 10, under Readmission to patient care, line 10 - I think you meant to say 'Increased risk of readmission' and not 'mortality'. 3. The supplementary tables 8c and 9c give a lot of valuable information and I think it would be useful to include a more detailed description of those results in the discussion. ****** 6. 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 Reviewer #2: Yes: RAFAEL FERNANDEZ Reviewer #3: Yes: Manisha Arthur ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. 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Revision 1
9 Aug 2022 Author Response RESPONSE TO REVIEWERS IS ALSO INCLUDED IN THE REVISED COVER LETTER Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf RESPONSE: This has been addressed. 2. We note that you have stated that you will provide repository information for your data at acceptance. Should your manuscript be accepted for publication, we will hold it until you provide the relevant accession numbers or DOIs necessary to access your data. If you wish to make changes to your Data Availability statement, please describe these changes in your cover letter and we will update your Data Availability statement to reflect the information you provide. RESPONSE: Thank you, we intend to store the de-identified analysis data and analysis code on the following OSF site: https://osf.io/cg8ab/ once the manuscript is accepted for publication. We are still verifying levels of de-identified data which are appropriate to include but will have complete data uploaded upon acceptance. 3. Please include your tables as part of your main manuscript and remove the individual files. Please note that supplementary tables (should remain/ be uploaded) as separate "supporting information" files RESPONSE: Tables have been included in manuscript and supplementary tables have been uploaded as supporting information files. 4. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. RESPONSE: Captions have been included. [Note: HTML markup is below. Please do not edit.] 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 Reviewer #2: Yes Reviewer #3: Yes ________________________________________ 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: Yes ________________________________________ 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: No Reviewer #2: Yes Reviewer #3: Yes ________________________________________ 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 Reviewer #2: Yes Reviewer #3: Yes ________________________________________ 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: Thank you for submitting your research article entitled “Mechanical ventilation for COVID-19: outcomes following discharge from inpatient treatment”. Authors evaluated the long-term outcomes of severe COVID-19 patients with or without mechanical ventilation (MV), its impacts on the hospital readmission, all-cause mortality, and reason for readmission. I think this manuscript is very meaningful for all medical personnel who are involved in COVID-19 pandemic. However, there are some major concerns that should be addressed by the authors at this time. 1. First of all, I think the topic of this study have little impact for the readers of this journal so that authors have not fully discussed in the DISCUSSION section. It is easy to imagine that the clinical prognosis of cases requiring mechanical ventilation is poor not only for other infections but also for COVID-19. Are there any differences in the characteristics or prognostic tendencies peculiar to patients with COVID-19? RESPONSE: While we agree with the reviewer that some aspects of the current study reflect common sense findings (e.g. patients receiving mechanical ventilation have worse outcomes in follow-up) we disagree that the findings will have little impact on readers. We have clarified in the discussion (on page 28 of the revised manuscript) that though the association between MV treatment and adverse outcomes (such as readmission and mortality) shown in the current sample is comparable or less than other studies of MV for ARDS, the data we present is still extremely useful. This is because the mechanisms by which COVID-19 leads to respiratory distress may differ from traditional ARDS and because MV treatment for COVID-19 is not applied in the same manner as MV treatment for non-COVID-19 respiratory distress. Because the COVID-19 presents unique challenges to physicians treating respiratory distress, we feel the current results are worthy of adding to the literature. 2. In the INTRODUCTION section, authors described that MV can produce lung injury, which lead to poor long-term outcomes in this condition. Among the present study populations, authors should discuss whether these poor outcomes and high readmission rates are due to the effects of mechanical ventilation management, the complications of COVID-19, or other factors? RESPONSE: This is a critical distinction to make. Unfortunately given the available data, we believe that this analysis is beyond the scope of the current manuscript. Because knowledge about treating COVID-19 illness was evolving during the early course of the pandemic, it is difficult to identify whether the findings relate intrinsically to COVID-19 or are due to implementation of MV treatment. We have added a sentence to the limitations section on page 30 of the revised manuscript specifically articulating this stating: “Further it is difficult to identify ascertain the exact mechanisms of the association between MV and the adverse outcomes shown in this sample.; These associations could be it is possible that the associations are due to factors associated with COVID-19 illness, issues with the application of MV treatment, or some other unknown factor.” 3. Authors described the limitation of data sampling in terms of readmission rate. Although I am not sure how many patients’ readmissions this healthcare system (Northwell Health) can cover, this limitation should be fully discussed since readmission rate is a primary outcome in this study. I would like to know how far the readmission rate in this study is from the real-world readmission rate. RESPONSE: Thank you for this comment. We agree it is important to contextualize the extent to which the Northwell Health readmission rate is comparable to other local or national rates. To address this question, we considered the following information: (1) data collection during the early pandemic was varied across the country in terms of sample size, variable outcome type, and follow-up, resulting in a range of estimations of the “true” readmission rate nationally; (2) literature suggests that United States readmission rates were estimated to be between 4.5% and 19.19% We thus consider our readmission rate of 11.4% to be appropriately represent the New York area. 4. Are there any standardized manual for MV management in these 23 medical facilities? If not, how did the physicians decide the indication of MV? Did you employ high-flow nasal cannula (HFNC) or non-invasive positive pressure ventilation (NPPV)? Moreover, are there any relationships between the duration of the intubation and readmission rate? RESPONSE: The authors appreciate this comment and agree that a standardizing of practices for implementation ofing MV would aid in the interpretation of the findings. However, at the time of data collection, standards for COVID-19 treatment were still being developed, both across and within hospital systems. Given the variable nature of these decisions during the early pandemic, a standard is not available for this particular dataset. We’ve also clarified that MV guidelines for COVID-19 were developing during the early pandemic in revisions to the introduction on page 4 of the revised manuscript. In response to your second question, while we agree that examining the relation between duration and of intubation and readmission rate would provide important information. However, the goal of the current analysis was to compare patients treated with MV to a matched cohort who were not treated with MV. To eExamininge the association between ventilation duration and outcomes would require analysis of a different cohort and using a different design. While we do believe those analyses are important, we also believe it is beyond the scope of the current manuscript. 5. In the CONCLUSIONS, second paragraph [P15L11-P16L2] is not based on the data of this research. This is not conclusion of this study. RESPONSE: We agree that this paragraph is not based on the data, and have therefore incorporated it into the discussion section rather than the conclusions. 1. [P5L18] January 31, 2020 -> January 31, 2021 RESPONSE: Change applied. 2. There are no “Table 1”, ”Table2” and “Table 3”. RESPONSE: We have incorporated the tables into the body of the manuscript. 3. For propensity score matching, please list the factors in order to make the adjustments. RESPONSE: We agree that additional details are required to clarify which variables were used to match the MV and non-MV patients. We have revised the section discussing propensity scoring on pages 8 and 9 to include all details of which variables we utilized and the methods which that were utilized for the matching process. We have also expanded our description of confounding variables which were used in the matching process on pages 6 and 7 of the revised manuscript. Reviewer #2: Butler et al. reported the outcome of COVID-19 patients following discharge differentiating between those who needed mechanical ventilation and those without it. As expected, patients who required MV were more susceptible to readmission and lower survival. The authors state that this feature is clearly recognized in ordinary ICU patients (not COVID), so the objective of this study should be clarified. Was their hypothesis that COVID patients behave differently (better or worse) than ordinary ICU patients? Then, the readers should be informed about how different the present results are compared with series of non-COVID patients. Nevertheless, even these comparisons are tricky because non-COVID severe ARF commonly affect patients with severe sepsis or severe comorbidities that explained most of the long-term outcome worsening. RESPONSE: The reviewer is correct about the goal of the study. Comparisons of MV treatment for COVID-19 and non-COVID-19 ARDS are difficult for many reasons. The most salient being that MV was not uniformly and rigorously applied for patients with severe COVID-19, especially early in the pandemic when hospital systems were overburdened and resources were scarce. We also agree with the reviewer that the mechanisms of outcomes following MV for ARDS may differ between COVID-19 and non-COVID-19 patients. As such, we have clarified our goals in the introduction. Our goal hope for this paper is to describe outcomes among patients who were treated with MV for COVID-19 and to highlight the need for additional follow-up and support among this population. Additional comments: 1.- Page 15, conclusions should be tailored by deleting the first 3 lines: “MV is an essential treatment ……... important”. Also, the second paragraph about possible solutions must be moved to the end of the discussion section. RESPONSE: Thank you, these changes have been applied. Reviewer #3: This is a very well done and well written study. I have a few minor corrections. 1. When the patient gets readmitted and is assigned the ICD category code of COVID 19 - does that mean he's got a re-infection, is PCR positive or has just recovered from COVID-19? It would be nice if there is one line to elaborate what that ICD code includes. (Page 7) RESPONSE: Thank you for this comment. Three codes were included under the COVID-19 umbrella: U07.1 (confirmed diagnosis of COVID-19 documented by provider, a positive COVID-19 test, or a presumptive positive COVID-19 test) and J12.82 (pneumonia due to COVID-19). We’ve clarified that these diagnoses correspond to COVID-19 being a reason for readmission in the text. We have also clarified that Supplementary Table 1 shows all ICD-10 codes and how they relate to reasons for readmission. 2. In page 10, under Readmission to patient care, line 10 - I think you meant to say 'Increased risk of readmission' and not 'mortality'. RESPONSE: Thank you, yes, this change has been applied. 3. The supplementary tables 8c and 9c give a lot of valuable information and I think it would be useful to include a more detailed description of those results in the discussion. RESPONSE: We agree and have expanded our discussion of these sensitivity analyses in the results and the discussion sections of the paper. We have also clarified that these sensitivity analyses suggest the magnitude of the association between MV and outcomes may differ among sub-populations of patients with COVID-19 illness. We have also clarified noted that because of the small number of events in these sensitivity analyses, our results should be interpreted cautiously. ________________________________________ 6. 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 Reviewer #2: Yes: RAFAEL FERNANDEZ Reviewer #3: Yes: Manisha Arthur https://doi.org/10.1371/journal.pone.0277498.r002
28 Oct 2022 Decision Letter - Masaki Tago, Editor Mechanical Ventilation for COVID-19: Outcomes Following Discharge from Inpatient Treatment PONE-D-22-12638R1 Dear Dr. Butler, 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. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. 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, Masaki Tago, M.D., Ph.D., FACP. Academic Editor PLOS ONE Additional Editor Comments (optional): 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 Reviewer #2: (No Response) Reviewer #3: All comments have been addressed ******** 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 Reviewer #2: Partly Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes Reviewer #3: 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 Reviewer #2: Yes Reviewer #3: No ****** 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 Reviewer #2: Yes Reviewer #3: Yes ****** 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: Thank you for resubmitting your updated research article entitled “Mechanical ventilation for COVID-19: outcomes following discharge from inpatient treatment”. The authors responded appropriately to my questions and comments. I agree with your views and with the content of the revised paper. I believe that this research paper will be of high value not only to medical professionals working with COVID-19 pandemic, but also to epidemiological statisticians and the many citizens who need such information. Again, thank you for submitting your manuscript to this journal. Reviewer #2: The authors have not answered my comments about a completely new reorientation. From my point of view MV Covid patients must be compared with MV NonCovid patients instead of nonventilated Covid. In the present form, I think that the manuscript does not offer any new information. Reviewer #3: All comments have been addressed. ****** 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 Reviewer #2: No Reviewer #3: No ******** https://doi.org/10.1371/journal.pone.0277498.r003
Formally Accepted
29 Dec 2022 Acceptance Letter - Masaki Tago, Editor PONE-D-22-12638R1 Mechanical ventilation for COVID-19: Outcomes following discharge from inpatient treatment Dear Dr. Butler: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. 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. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Masaki Tago Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0277498.r004

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