Utility of High Flow Nasal Cannula during Pulmonary Rehabilitation in COVID-19 Patients in Acute Respiratory Failure

Round 1

Reviewer 1 Report

It is an interesting study and I also appreciate the fact that the authors mentioned the limitations of the study. The number of 22 subjects is insufficient for a research group. The fact that there is no control group worries me the most.

 

I have several questions/recommendations:

 

1. The study group includes patients older than 45 years ( row 101. I believe that the age gap between the study group's bottom and upper ages is too wide. Will a 45-year-old patient have the same therapeutic response as a 70-year-old patient?
2. In the inclusion criteria, you mentioned antibiotic therapy when necessary ( row 105).You have an uncontrollable variable here, because the administration of antibiotic therapy can influence the final result.
3. How many patients were registered in total before the inclusion and exclusion criteria were applied?
4. My main issue is the lack of a control group. In its absence, I don't believe you have a basis for comparison, and you can only draw conclusions empirically.
5. The references chapter does not fully respect the recommended style

 

In conclusion, your results in the use of a High Flow Nasal Cannula during pulmonary rehabilitation in Covid 19 patients are encouraging, but I believe that in order to have scientific results and conclusions, you should work on expanding the study group, introducing a control group, and controlling certain variables that could influence the end result.

 

Author Response

Dear Reviewer,

 

many thanks for your suggestions. Then, we have just modified in the manuscript “in red color” as possible and answered point by point:

 

1. The study group includes patients older than 45 years. I believe that the age gap between the study group's bottom and upper ages is too wide. Will a 45-year-old patient have the same therapeutic response as a 70-year-old patient?

 

 AUTHORS: The analyzed sample reports an average age of 64.5 years and standard deviation of 5.9 years old: we included patients> 45 years precisely to avoid a too wide age "gap", excluding younger patients. Furthermore, we have taken into account and tried to respect, in order to avoid age bias, a homogeneity of patients at baseline, the terms of severity of disease and performance on tests. For greater clarity, we have specified the inclusion criteria better than age.

 

 

1. In the inclusion criteria, you mentioned antibiotic therapy when necessary. You have an uncontrollable variable here, because the administration of antibiotic therapy can influence the final result.

 

AUTHORS: Thanks for this comment, we have specified this part more correctly:

All enrolled patients were treated with steroid therapy, prophylactic dose low molecular weight heparin and (Azithromycin antibiotic therapy), those with bacterial over infection received broad-spectrum piperacillin tazobactam antibiotic therapy or targeted antibiotic therapy if isolates were present.

 

 

1. How many patients were registered in total before the inclusion and exclusion criteria were applied?

 

AUTHORS: The number of patients considered before application of the inclusion and exclusion criteria was 30. Some of those not reported in the study had aggravated pneumonia and therefore underwent NIV, others had other complications which made them unsuitable for physiotherapy tests.

 

 

1. My main issue is the lack of a control group. In its absence, I don't believe you have a basis for comparison, and you can only draw conclusions empirically.

 

AUTHORS: This study was conducted in the absence of a control group, and it is a limitation, added in the discussion and we have modulated the conclusions on this consideration of yours. Future studies will take into account CG in order to further investigate the extent of support that the use of HFNC in the rehabilitation setting provides with regard to treatment tolerance and achievement of outcomes.

 

 

1. The references chapter does not fully respect the recommended style

 

 

AUTHORS: Thanks for this comment, we checked and made corrections

 

 

Author Response File: Author Response.docx

Reviewer 2 Report

Thank you for inviting me to review this manuscript on hot topic: Utility of High Flow Nasal Cannula during pulmonary rehabilitation in Covid 19 patients in Acute Respiratory Failure.

 

I can propose several points:

1. Please extend limitation of your study
2. Statistics is only descriptive, I think you can apply and another statistical methods with possible revision of discussions and conclusions
3. Table 1 must be revised: I think here you can present and another data about your patients, for comorbidities you can do another one table or can present data as a figure
4. Please revise discussions, please do detailed analysis of your data with comparison with similar studies
5. Please cite and discuss this fresh article on the topic:

Diagnostics | Free Full-Text | Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation (mdpi.com)

 

Author Response

Dear Reviewer,

 

many thanks for your suggestions. Then, we have just modified in the manuscript “in red color” as possible and answered point by point: 

1. Please extend limitation of your study

 

AUTHORS: thanks for this comment, we have just described the limitation of the study

 

 

1. Statistics is only descriptive; I think you can apply and another statistical method with possible revision of discussions and conclusions

 

AUTHORS: Dear Reviewer, you are right, but the small size of the sample and the lack of a control group made us opt for a simple statistical analysis where together with the descriptive part the student's t-test was adopted

“A descriptive analysis was expressed as mean ± standard deviation (SD) and t-Student test was used for significance testing, as appropriate for paired samples. Significance was indicated by a P value < 0.05 “

 

 

 

1. Table 1 must be revised: I think here you can present and another data about your patients, for comorbidities you can do another one table or can present data as a figure

 

AUTHORS: We tried a graphic representation like a pie chart but the sum of the percentages exceeded 100% because some patients present more comorbidities, so in our opinion the table is the most appropriate way to represent them.

 

1. Please revise discussions, please do detailed analysis of your data with comparison with similar studies

 

AUTHORS: Done

 

1. Please cite and discuss this fresh article on the topic:

 

AUTHORS: Done

Diagnostics | Free Full-Text | Management of COVID-19-Associated Acute Respiratory Failure with Alternatives to Invasive Mechanical Ventilation: High-Flow Oxygen, Continuous Positive Airway Pressure, and Noninvasive Ventilation (mdpi.com)

 

Author Response File: Author Response.docx

Round 2

Reviewer 1 Report

I have reviewed the revised document. I agree with the publication in its current form.

Reviewer 2 Report

Accept as it!