Pathomechanisms of Non-Traumatic Acute Brain Injury in Critically Ill Patients

Round 1

Reviewer 1 Report

I read the manuscript “Pathomechanisms of non-traumatic acute brain injury in critically ill patients” from Dabrowski W. et al. with great interest.

By this well-written review article the authors give an excellent overview about relevant pathomechanisms related to the highly important field of delirium in critically ill patients.

I have no concerns.

Author Response

Thanks

Reviewer 2 Report

Dear authors

This is a good work

Author Response

thanks

Reviewer 3 Report

More attention is needed to spelling and English grammar  (eg ref sp Psychiatry  etc) 

A table of each mechanism contributing to delirium will help clarify.  If so which Rx is specific 

The final section on 'natural medicines'  is not evidence based.  It is overly speculative: would not pass muster for therapy as recommendations doses etc are highly non specific.  It would be better to omit this section all together and focus on conventional therapy for each aspect of delirium:  mainly oxygen and correction of metabolic disorders

Author Response

Dear Reviewer.

We thank the reviewers for their review of our manuscript. We have corrected our manuscript according to the reviewers' comments. We deleted the last paragraph, added the table with each mechanism contributing to delirium, and added figure 1 with the tryptophan pathway. We've submitted the corrected version of our manuscript.

 

Sincerely Yours

Wojciech Dabrowski on behalf of all co-authors

 

 

Round 2

Reviewer 3 Report

Now that the authors have eliminated the section on natural medicines, it would be advisable to discuss treatment of the three different subtypes based upon their elaborate phenomenology. Exactly how does this analysis advance diagnosis and treatment?

Author Response

Dear Reviewers

We thank the reviewers for their helpful follow-on second review of our manuscript medicina-901196 under the title: "Pathomechanisms of non-traumatic acute brain injury in critically ill patients". We adjusted the manuscript per the reviewers' additional comments. We added a short section with treatment of delirium, in which we generally described a treatment from the pathomechanisms as well as the type of delirium. We hope that our manuscript meets the reviewers’ requirements

Wojciech Dabrowski on behalf all co-authors

Round 3

Reviewer 3 Report

The paper still contains many misspellings eg stanins for statins and others. I suggest the authors go back and take time to assure accuracy and not to impose a hastiness to publish upon a reading public.  The treatment section begins to improve but  the most notable treatments oxygen for hypoxia  and correction of underlying electrolyte disorders, needs emphasis over eg melatonin.  I do  not believe correcting sleep disorders is "easy".  May I request that the authors take more time and respond in a thoughtful, precise and considered manner with a revision suitable for consideration as an addition to the medical scientific literature.  This MS needs more time and work. 

Author Response

Dear Reviewer

Thank You for Your usable comments. We corrected our manuscript adding some sentences with general rules of delirium treatment and blood oxygen monitoring. We hope, our amendments improve the paragraph describing delirium treatment. We also correct the English language. 

Sincerely Yours

Wojciech Dabrowski on behalf of all co-authors