Dear Dr. Wagstaff,

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Kind regards,

Chinh Quoc Luong, MD., PhD.

Academic Editor

PLOS ONE

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Additional Editor Comments:

The study evaluated ventilator liberation practices in three Vietnamese ICUs using robust methodologies despite resource constraints. While the work highlights significant limitations impacting care, it provides a valuable foundation for improving medical practices in the region. However, Reviewer 3 noted that the paper would benefit from referencing clinical practice guidelines and discussing how these guidelines could be adapted to Vietnam's unique context, offering a framework for future enhancements in care quality. Please address the comments below and resubmit your manuscript for further consideration.

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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?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: N/A

Reviewer #2: N/A

Reviewer #3: 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: No

Reviewer #2: Yes

Reviewer #3: Yes

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

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

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Reviewer #1: This is a nicely written and thorough analysis of an important clinical issue with important clinical ramifications.

The authors would be commended for the hard work at producing this work. Simultaneously, while the data is useful and has relevant findings for implementation scientists around the world, it is often over-long in the Discussion, which often rehashes many of the points raised in the Results. This could be edited down to enhance readability.

Limitations could also be expanded, so as to focus on some of the sampling issues from the three ICUs, ie very limited nursing staff involved.

Reviewer #2: This study is a very important contribution in developing evidence regarding quality improvement in critical care processes in the LMIC setting. Well done to the authors for this piece of work. The rapid mixed method process evaluation brings out the barriers that are faced in the ICUs to implement the sedation assessment, SAT and SBTs. The contextually sound recommendations to enable the implementation of a QI initiative to improve these processes are practical and potentially feasible.

Reviewer #3: March 27, 2025

To The Editors:

Thank you very much for allowing me to review the article by Luu and coworkers entitled “A rapid evaluation of quality of sedation and ventilation care processes for critically ill patients in Vietnam”. I found this paper to be interesting and informative. The authors used a variety of methods to assess practices in three intensive care units in Vietnam regarding ventilator liberation. I found the methods used to assess practices to be excellent. Resource limitations have a significant impact on ventilator liberation practices in Vietnam. This work not only highlighted the fact that limitations exist, but provided detailed assessments that will allow physicians in this region to improve medical care.

If I were to make a critical comment about this work, it would be that there should be references to clinical practice standards and guidelines in the domain of ventilator liberation. Clearly, such guidelines have been developed only for research-rich environments and could not be applied to intensive care units in Vietnam without modification. However, tools are available to modify existing clinical practice guidelines to regions and nations where there are differences in population demographics and economic situations from those regions for which the original guidelines were developed. This additional commentary could provide a template for future improvements in the quality of care in Vietnam.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: Yes: Daniel R. Ouellette MDDaniel R. Ouellette MD

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Attachments

Attachment

Submitted filename: Commentary Luu PlosOne 032725.docx

A rapid evaluation of quality of sedation and ventilation care processes for critically ill patients in Vietnam

PONE-D-24-29941R1

Dear Dr. Wagstaff,

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,

Chinh Quoc Luong, MD., PhD.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

The revised manuscript now fully satisfies the publication standards of PLOS ONE. The authors have comprehensively addressed all editorial and reviewer feedback, resulting in a study that is methodologically rigorous, clearly articulated, and fully compliant with journal policies. Their investigation into sedation and ventilation practices in Vietnamese Intensive Care Units offers valuable evidence for critical care in Low- and Middle-Income Country contexts, and the revisions have further strengthened the study’s clarity, generalizability, and practical significance.

Reviewers' comments: