Peer Review History

Original SubmissionJuly 12, 2019
Decision Letter - Federico Bilotta, Editor

PONE-D-19-19686

Detection of posttraumatic pneumothorax using Electrical Impedance Tomography - An observer-blinded study in pigs with blunt chest trauma

PLOS ONE

Dear Dr. Girrbach,

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Federico Bilotta

Academic Editor

PLOS ONE

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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: Yes

Reviewer #2: Yes

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

Reviewer #1: Yes

Reviewer #2: 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

Reviewer #2: 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

Reviewer #2: 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: Thank you for the opportunity to revise this manuscript.I found this experimental study really interesting, with a robust methodology and an important and clear message, possibly easy to apply in the clinical practice. Also, the authors should be congratulated because of the attempt to find tools able to provide clinical findings at the patients bedside.The manuscript is well written.

I have some minor suggestions:

There are some typo mistakes, please revise the entire manuscript for English and grammar

Introduction: Line 69-70. This information (…may convert to tension pneumothorax..) is redundant

Please add in the introduction some informations about the principles of EIT

The discussion section should be structured according to the order of the results. In this form it is really confusing.

Reviewer #2: 1. ABSTRACT.

- Abstract appropriately summarize the manuscript.

- There aren´t discrepancies between the Abstract and the remainder of the manuscript.

- The Abstract can be understood without reading the manuscript.

2. BACKGROUND/AIM

- The Introduction is concise.

- The purpose of the study is well defined.

- The authors provide a rationale for performing the study based on a review of the medical literature with an appropriate length.

- This manuscript is Original Research, with a well-defined hypothesis.

3. MATERIALS AND METHODS

- Please, define and explain more accurate the study design.

4. RESULTS

- The results are clearly explained.

- The results are reasonable and expected.

- There aren´t results introduced that are not preceded by an appropriate discussion in the Methods section.

5. DISCUSSION

- The discussion is concise.

- Their research question was answered.

- Authors’ conclusions are justified by the results found in the study.

6. FIGURES

- Figure is appropriate and it is appropriately labeled.

- Adequately show the important results.

7. TABLES (Supl)

- Appropriately describe the results.

8. REFERENCES

- The reference list follows the format for the journal.

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Reviewer #1: No

Reviewer #2: Yes: Rafael Badenes

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Attachments
Attachment
Submitted filename: Badenes Review PLOS ONE 4.docx
Revision 1

RESPONSE TO REVIEWER #1

Thank you for your valuable suggestions. We changed the manuscript accordingly:

- The entire manuscript was revised concerning English and grammar

- The redundant information in line 69-70 was deleted. According, we changed the sentence in line 60 as follows: “Undiagnosed, occult pneumothoraces may convert to tension pneumothorax - particularly after initiating mechanical ventilation - and require emergency thoracostomy (2, 3).”

- As suggested, we inserted some information about the principles of EIT in the introduction

- The discussion section was restructured as suggested

RESPONSE TO REVIEWER #2

Thank you also for your helpful suggestions. We changed the manuscript according to your suggestion:

- The study design is defined and explained more accurate in the revised manuscript. The first paragraph of the methods section was changed as follows:

“In compliance with the 3R’s for reduction of animals in research (https://www.nc3rs.org.uk/the-3rs), we used suitable data from an existing institutional database in this experimental, observer-blinded diagnostic study. The original experiment was approved by the governmental animal ethics committee (Landesdirection Leipzig, reference number TVV38/11). Pigs (German Landrace) were received from a conventional pig-breeding farm and were kept at the Large Animal Clinic for Surgery, Faculty of Veterinary Medicine, University of Leipzig in a species-specific environment.

From this database, we randomly obtained 100 EIT files and the corresponding CT data from 17 different pigs. The files were anonymized and observers were blinded to all other information. Two observers (specialists in anesthesiology and intensive care) analyzed the randomly obtained 100 EIT files, while a third observer (specialist in radiology) analyzed the corresponding CT images. “

Attachments
Attachment
Submitted filename: Response to Reviewers.docx
Decision Letter - Federico Bilotta, Editor

Detection of posttraumatic pneumothorax using Electrical Impedance Tomography - An observer-blinded study in pigs with blunt chest trauma

PONE-D-19-19686R1

Dear Dr. Girrbach,

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

Within one week, you will receive an e-mail containing information on the amendments required prior to publication. When all required modifications have been addressed, you will receive a formal acceptance letter and your manuscript will proceed to our production department and 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 enable them to help maximize its impact. If they will be preparing press materials for this manuscript, you must inform our press team as soon as possible and 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.

With kind regards,

Federico Bilotta

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

PONE-D-19-19686R1

In this observed study, the Authors analyzed an existing database of 17 mechanically ventilated pigs, which had sustained standardized blunt chest trauma and had undergone repeated thoracic CT and EIT.

100 corresponding EIT/CT datasets were randomly chosen from the database and anonymized. Two independent and blinded observers analyzed the EIT data for presence and location of PTX. Analysis of the corresponding CTs by a radiologist served as reference.

Results 87/100 cases had at least one PTX detected by CT. Fourty-two cases showed a PTX > 20% of the sternovertebral diameter (PTXtrans20), whereas 52/100 PTX showed a PTX>3 cm in the craniocaudal diameter (PTXcc3), with 20 cases showing both a PTXtranscc and a PTXcc3. We found a very low agreement between both EIT observers considering the classification overall PTX/noPTX (κ=0.09, p=0.183).

The Authors concluded that, multimodal imaging approaches, technical improvements and image postprocessing algorithms might improve the performance of EIT for diagnosing PTX in the future.

Comments

Reviewer 1: The authors have addressed my concerns and should be congratulated for the effort in the revisions. Thank you. Accept

Reviewer 2: The authors have satisfactorily responded to all my questions and made the necessary changes to the manuscript. Accept

Academic editor: considering changing and positive feedback from the reviewers I’m informed you that your manuscript is 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

Reviewer #2: 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

Reviewer #2: Yes

**********

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

Reviewer #1: Yes

Reviewer #2: 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: No

Reviewer #2: 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 #1: Yes

Reviewer #2: 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: The authors have addressed my concerns and should be congratulated for the effort in the revisions. Thank you.

Reviewer #2: The authors have satisfactorily responded to all my questions and made the necessary changes to the manuscript.

**********

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: Yes: Rafael Badenes

Formally Accepted
Acceptance Letter - Federico Bilotta, Editor

PONE-D-19-19686R1

Detection of posttraumatic pneumothorax using Electrical Impedance Tomography - An observer-blinded study in pigs with blunt chest trauma

Dear Dr. Girrbach:

I am 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 notify them about your upcoming paper at this point, to enable them to help maximize its impact. If they will be preparing press materials for this manuscript, 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.

For any other questions or concerns, please email plosone@plos.org.

Thank you for submitting your work to PLOS ONE.

With kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Federico Bilotta

Academic Editor

PLOS ONE

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