Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis

Temesgen Ayenew; Mihretie Gedfew; Mamaru Getie Fetene; Belayneh Shetie Workneh; Animut Takele Telayneh; Afework Edmealem; Bekele Getenet Tiruneh; Guadie Tewabe Yinges; Addisu Getie; Mengistu Abebe Meselu

doi:10.1371/journal.pone.0306277

Peer Review History

Original SubmissionJanuary 9, 2024
17 Apr 2024 Decision Letter - Kahsu Gebrekidan, Editor PONE-D-24-00386Prevalence of Mortality of Mechanically Ventilated Patients and Associative Factors in Intensive Care Units of Ethiopian Hospitals: A Systematic Review and Metanalysis.PLOS ONE Dear Dr. Ayenew, 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. Please submit your revised manuscript by Jun 01 2024 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. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. 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, Kahsu Gebrekidan 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. 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: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: I Don't Know ****** 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 Reviewer #2: 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 ****** 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 article is simple and straightforward and the topic is interesting to read. The abstract summarizes the paper well and the intro clarifies the objective and rationale behind the study. The method is adequately described. The strategy behind the review and meta analysis was clearly described. Risk of bias was assessed. Variables, outcomes and associative factors were clearly shown and explained. Data were consistent with findings and limitations were transparently discussed. I have one question, I was curious as to why the number of included studies became 22 for the final systematic review and meta-analysis? Based on what did you exclude the last 4 studies from the 26 studies? It would be great if you could clarify that. Also, I would suggest adding legends to the figures. Thank you for you efforts in writing this paper. Reviewer #2: The text discusses a systematic review that aims to answer a frequently asked question, but it is limited to a specific country that the authors belong to. Although several publications have addressed this question, the review was conducted following the PRISMA guidelines for systematic reviews and meta-analyses. However, certain areas require clarification, as the article may not be entirely clear. Below are some areas or points that need clarification, revision or highlighting. The abstract section: Establishing cause-and-effect relationships can be challenging when conducting a systematic review using observational studies. These studies merely observe and record events without manipulating variables. Therefore, it is crucial to explicitly state this limitation in the abstract's conclusion, refraining from making claims that the available evidence cannot substantiate. Methods section The study's inclusion criteria were carefully designed to be specific and broad enough to cover a wide range of patients. Although the mortality rates between adult and pediatric ICU patients were significantly different, age differences were not considered a distinguishing factor to ensure a comprehensive review that encompasses all relevant studies. The study's secondary outcome was not specified or mentioned in the methods sections, making it unclear which factors the systematic review will focus on. Result section : For subgroup analysis, it may be helpful to consider the study type (cohort or cross-sectional) and age differences (adults and pediatrics). Why did they choose this publication and sample size to check the cause of heterogeneity of the article? The weight of each study was around 4. As I am not a statistician, I wonder how they get similar weights for different studies with varying populations and sample sizes. The secondary outcome in the Results section should be rewritten. I’m not sure if the OR is adjusted or the raw OR. Discussion section : Most of the area is covered. However, the final conclusion needs to be rewritten. The first part concerning prevalence is acceptable, but the second part needs to be reworded. ****** 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: No ******** [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/. 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Revision 1
22 Apr 2024 Author Response A point-by-point response to review comments to the author Dear Editor and reviewers, we are very grateful for your constructive comments to our submitted manuscript. Your comments are of great value. We have addressed them point by point in the revised manuscript. The revisions are indicated with tracked changes in the revised manuscript. Here below is a table showing point by point responses to your comments. Editor’s comments Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. • Thank you for your feedback. It is corrected as recommended. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. • Thank you for your feedback. It is corrected as recommended in the revised version Reviewer #1 I was curious as to why the number of included studies became 22 for the final systematic review and meta-analysis? Based on what did you exclude the last 4 studies from the 26 studies? It would be great if you could clarify that. • Thank you so much, we have explained it in the revised manuscript on page 6 I would suggest adding legends to the figures • Thank you, figure legends are incorporated throughout the whole manuscript Reviewer #2 Abstract Establishing cause-and-effect relationships can be challenging when conducting a systematic review using observational studies. These studies merely observe and record events without manipulating variables. Therefore, it is crucial to explicitly state this limitation in the abstract's conclusion, refraining from making claims that the available evidence cannot substantiate. • Thank you so much, we really appreciate your comments. It is addressed in the revised manuscript at the conclusion of the abstract section and at the conclusion section of the manuscript on pages 3 & 13 Methods The study's inclusion criteria were carefully designed to be specific and broad enough to cover a wide range of patients. Although the mortality rates between adult and pediatric ICU patients were significantly different, age differences were not considered a distinguishing factor to ensure a comprehensive review that encompasses all relevant studies. • Thank you in advance, actually we didn’t restrict our inclusion criteria using age category. So, we have revised the inclusion criteria to include a statement “both pediatric and adult ICU-admitted patients” to make it clearer for readers that we had considered age categories on page 5 The study's secondary outcome was not specified or mentioned in the methods sections, making it unclear which factors the systematic review will focus on. • Dear reviewer, thank you so much. We have addressed it in the revised manuscript on page 5. Results For subgroup analysis, it may be helpful to consider the study type (prospective cohort, retrospective cohort and cross-sectional) and age differences (adults and pediatrics). • Thank you so much, sub-group analysis was done using these variables in the revised manuscript on page 8 Why did they choose this publication and sample size to check the cause of heterogeneity of the article? • Dear reviewer, thank you so much. we use sample size, JBI quality and publication year to run meta-regression analysis. Meta-regression analysis command uses only integer variables and do not allow string variables like region and study design on pages 9-10 The weight of each study was around 4. As I am not a statistician, I wonder how they get similar weights for different studies with varying populations and sample sizes. • Dear reviewer, thank you for your concerns. Yes, of course, the weight of each study is almost close to 4. This might be because we used a random effects model. Under the random-effects model the goal is not to estimate one true effect, but to estimate the mean of a distribution of effects. Since each study provides information about a different effect size, we want to be sure that all these effect sizes are represented in the summary estimate. This means that we cannot discount a small study by giving it a very small weight. The estimate provided by that study may be imprecise, but it is information about an effect that no other study has estimated. By the same logic we cannot give too much weight to a very large study. Our goal is to estimate the mean effect in a range of studies and we do not want that overall estimate to be overly influenced by any one of them. The secondary outcome in the Results section should be rewritten. I’m not sure if the OR is adjusted or the raw OR. • Dear reviewer, thank you for your suggestion. The odds ratio is the pooled odds ratio (adjusted) after meta-analysis of significant variables from individual studies. Discussion Most of the area is covered. However, the final conclusion needs to be rewritten. The first part concerning prevalence is acceptable, but the second part needs to be reworded. • Dear reviewer, thank you for your suggestion, we have made revisions in the conclusion on page 13 Finally, thank you so much again! Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0306277.r002
7 May 2024 Decision Letter - Kahsu Gebrekidan, Editor PONE-D-24-00386R1Prevalence of mortality of mechanically ventilated patients and associated factors in intensive care units of Ethiopian hospitals: systematic review and meta-analysisPLOS ONE Dear Dr. Ayenew, 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. Please submit your revised manuscript by Jun 21 2024 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. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. 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, Kahsu Gebrekidan Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 #2: All comments have been addressed Reviewer #3: (No Response) ******** 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 #2: Yes Reviewer #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: I Don't Know 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 #2: Yes Reviewer #3: Yes ****** 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 #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 #2: (No Response) Reviewer #3: Suggest to rephrase the title to "Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis" Line 85&86: "These include the presence of comorbidities, length of stay on MV, day and time of ICU admission, Glasgow coma scale (GCS) during admission" please specify the length of stay e.g more than seven days, and the GCS score of 11 and above (for example). line 185: please correct the spelling of heterogeneity Please check the journal format for abbreviating the word Figure, is it "Fig 2" or "Fig. 2" Line 247: please write in full " is not" ****** 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 #2: No Reviewer #3: No ******** [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. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0306277.r003
Revision 2
8 May 2024 Author Response Response to Reviewers Dear editor and reviewers, thank you for your constructive comments for the second time. We value your comments and we have addressed them point by point in the revised manuscript. The revisions are indicated with tracked changes in the revised manuscript. Here below is a point-by-point response to the reviewers and the editor. Journal Requirements Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. • Dear editor, thank you for your comments regarding the referencing style. We have made revisions. All of the references are changed to Vancouver style after seeing the PLOS Submission Guidelines references section on pages 14 – 18. No retracted articles were cited. Review Comments to the Author Reviewer #2: (No Response) Reviewer #3: Suggest to rephrase the title to "Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis" • Dear reviewer, thank you for your suggestion. The title is rephrased accordingly on pages 1 & 2 Line 85&86: "These include the presence of comorbidities, length of stay on MV, day and time of ICU admission, Glasgow coma scale (GCS) during admission" please specify the length of stay e.g more than seven days, and the GCS score of 11 and above (for example). • Dear reviewer we value your comments, revisions are made to make these specific on page 4 line 185: please correct the spelling of heterogeneity • Dear reviewer, thank you for your comments, the spelling is corrected on page 8 Please check the journal format for abbreviating the word Figure, is it "Fig 2" or "Fig. 2" • Dear reviewer, thank you for your comments, but according to manuscript body formatting guidelines of the journal figures are labeled as “Fig” not “Fig.” (https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf) Line 247: please write in full " is not" • Dear reviewer, thank you for your comments, the word is written in its full form as “is not” on page 11 Finally, thank you in advance for your prompt and constructive feedbacks. Sincerely, Temesgen Ayenew (corresponding author) Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0306277.r004
4 Jun 2024 Decision Letter - Kahsu Gebrekidan, Editor PONE-D-24-00386R2Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysisPLOS ONE Dear Dr. Ayenew, 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. Please submit your revised manuscript by Jul 19 2024 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. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols. Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. 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, Kahsu Gebrekidan Academic Editor PLOS ONE Journal Requirements: Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. [Note: HTML markup is below. Please do not edit.] 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 #3: (No Response) ******** 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 #3: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? 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 #3: Yes ****** 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 #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 #3: Dear Authors, 1) Please check spelling error throughout the article. I found a few, with in (should be within), and line 186 (spelling for heterogeneity), line 194 (spelling for yields). 2) Please check the grammar: I found error in line 272 and 273. based on the references (47& 48), there were two separate studies, therefore should use support (without s). ****** 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 #3: No ******** [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. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org. Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0306277.r005
Revision 3
6 Jun 2024 Author Response Response to Reviews Dear Reviewer, many thanks to your constructive feedbacks. We have extensively seen the whole manuscript for spelling and grammar errors. Here below is a point-by-point response to the reviewer’s comments. Reviewer #3 1. Please check spelling error throughout the article. I found a few, with in (should be within), and line 186 (spelling for heterogeneity), line 194 (spelling for yields). Dear reviewer, thank you for your comments, we have made spelling corrections to these words as well as other spelling errors throughout the manuscript. The corrections are indicated with tracked changes. 2. Please check the grammar: I found error in line 272 and 273. based on the references (47& 48), there were two separate studies, therefore should use support (without s). Dear reviewer, thank you for your comments, we have made grammar checks and made corrections to these sentence and others throughout the article. The corrections are indicated with tracked changes We really appreciate your feedback Temesgen Ayenew, corresponding author Attachments Attachment Submitted filename: Author Response to Reviews.docx https://doi.org/10.1371/journal.pone.0306277.r006
15 Jun 2024 Decision Letter - Kahsu Gebrekidan, Editor Prevalence of mortality among mechanically ventilated patients in the intensive care units of Ethiopian hospitals and the associated factors: A systematic review and meta-analysis PONE-D-24-00386R3 Dear Mr. Temesgen, 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 will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, 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, Kahsu Gebrekidan Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: https://doi.org/10.1371/journal.pone.0306277.r007
Formally Accepted
18 Jun 2024 Acceptance Letter - Kahsu Gebrekidan, Editor PONE-D-24-00386R3 PLOS ONE Dear Dr. Ayenew, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, 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 customercare@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. Kahsu Gebrekidan Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0306277.r008

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PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .