Accuracy and Sensitivity of Clinical Parameters in Predicting Successful Extubation in Patients with Acute Brain Injury

Round 1

Reviewer 1 Report

I think this is a good paper on some parameters for the successful extubation in Acute Brain Injury.

Paper is of interest for the readers.

An introduction is setting the scene well and it is well inserted. Good points and references.

Methods section with a good diagram and a good presentation in general.

Same goes with Results section. Good structure and the flow of the text is ok.

Limitations are fair.

Conclusions are balanced.

This manuscript can only add value to this new journal of MDPI family and I would suggest direct acceptance.

Author Response

We thank the feedback made by Reviewer #1. His/her suggestion of acceptance states for the quality of the manuscript. We believe that the journal Neurology International will provide a good visibility of our study. Thank you for your time in reviewing this study.

Reviewer 2 Report

Acute brain injury is a sudden injury that causes damage to the brain. Intubation is frequently used in these patients to provide airway protection. The authors reported that VISAGE score, maximum inspiratory and expiratory pressures, and peak cough flow together can accurately predict the success rates of extubation, where the VISAGE score has the greatest impact. A few comments will need to be addressed before consideration for publication.

Comments:

1) Can the authors briefly describe what the VISAGE score is in Introduction? It may be helpful to readers from other fields to understand the paper if the authors could provide a little bit more background information.

2) In Table 1, it showed that the hospitalization time of failure extubation group is significantly higher than the success extubation group. Does that mean that longer hospitalization could reduce the success rates of extubation?

3) It reported that Maximum inspiratory pressure can rise the change of extubation success by 2.47%. However, is this increase significant? Or is it necessary to include it in the model?

Author Response

We thank Reviewer #2 for his/her suggestions. We have made the following changes in the text, as recommended by the reviewer. 

1) With respect to comment 1, we included the text: “Recent instruments, such as the VISAGE score, try to increase extubation success by including neurologic parameters in the decision of extubation [15]. In the present study, we investigated clinical parameters (ventilatory and neurologic) associated to success extubation in patients with acute brain injuries…”

2) With respect to comment 2, we included the text: “In this study, patients that had a success and a failure extubation were similar as to anthropometric and clinical data (table 1). This observation is important because if these variables interfered in patients’ outcome, they did it on similar basis. The only difference between groups occurred for days of hospitalization, where patients that had failure extubation stayed longer in the intensive care unit. This finding corroborates previous studies and can indicate that a longer hospitalization time can reduce success rates of extubation [29,30].”

3) With respect to comment 3, we included the text: "In the present study both groups showed satisfactory MIP indexes, with a tendency of the success extubation group to have better score than the failure extubation group. The statistical model used in this research pointed out that a one-unit increase in MIP implied extubation success increase by 2.47%. This result may not be clinically relevant if we consider the impact of VISAGE score, much more representative in the statistical model than the MIP.

We thank Reviewer #2 for his/her time in reviewing this study.