Application and Technical Principles of Catheter High-Frequency Jet Ventilation

Round 1

Reviewer 1 Report

Thank you for the opportunity to review this manuscript. 

 

In this review article the authors review physics principles, technology, indications and practical aspects of catheter high frequency jet ventilation. The article is of potential interest to anaesthetists, ENT specialists and thoracic surgeons. However, I feel that the structure and the organisation of the paper could and perhaps should improve significantly in order to become understandable for clinicians who are not already expert in this ventilation mode.

 

Specific comments:

 

- The article is split to Methods, Results and Discussion sections, which bear no relevance for a review article.

 

- The risk of barotrauma is discussed at several point in the main text and in a Table. However, by now it is well known that it is not the high pressures but the high volumes are damaging to the lung (the high pressures can lead to lung damage by causing excessive tidal volumes). Therefore, volutrauma should be emphasized instead.

 

- Section 2.1. "High-Frequency Jet Ventilation". In its first sub-section 2.1.1. "Types of HFV Techniques" the authors then starts discussing all the other modes of high frequency ventilation. This is not logical.

 

- 2.1.1. "Types of HFV Techniques" - High-frequency flow interruption (HFFI) is not listed although that is also a HFV mode.

 

- "HFO (high-frequency oscillation) - high-frequency ventilation with a frequency 81 above 600 cycles/min" - HFOV sometimes uses frequency down to 7-8 Hz, that is, 420-480/min. 

 

- "From the point of view of the ventilation circuit closure to the atmosphere, HFV can be divided into closed (hermetic) and open (non-hermetic) systems." - this sentence is difficult to understand. During neonatal HFOV via endotracheal tubes, there is usually a leak (not sealed) because uncuffed endotracheal tubes are usually used in babies.

 

- Table 1: "Advangegous" - typo

 

- "A patient undergoing procedures that require a different way of securing the airways, or 240 the use of another interface between the ventilator and the patient is problematic or im- 241 possible. " - something is missing from this sentence.

 

- "This area allows you to choose from multiple techniques/approaches and replace the rou- 243 tine procedure of conventional ventilation (CV) with C-HFJV." - This reviewer does not understand what this sentence wants to say

 

- The "total stop: automatic shutdown system concept is only introduced towards the end of the paper and it needs more explanation.

 

- "Repeated insertion 268 of a Kleinsasser catheter can be avoided" - This term (Kleinsasser catheter )had not been mentioned before or explained

 

 

English could be improved

Author Response

We thank the reviewer for most constructive comments, all have been implemented and corrected, as suggested. As well as many sections rewritten for grammar and clarity. All changes are marked in red in the attached document arm-2406269.docx

Specific comments:

• The article is split to Methods, Results and Discussion sections, which bear no relevance for a review article.
• has been corrected and the article reordered in kind

 

• The risk of barotrauma is discussed at several point in the main text and in a Table. However, by now it is well known that it is not the high pressures but the high volumes are damaging to the lung (the high pressures can lead to lung damage by causing excessive tidal volumes). Therefore, volutrauma should be emphasized instead
• baro and volutrauma have been introduced and volutrauma emphasized

 

• Section 2.1. “High-Frequency Jet Ventilation”. In its first sub-section 2.1.1. “Types of HFV Techniques” the authors then starts discussing all the other modes of high frequency ventilation. This is not logical.
• has been changed

 

• 1.1. “Types of HFV Techniques” – High-frequency flow interruption (HFFI) is not listed although that is also a HFV mode.
• Is now included in the article

 

• “HFO (high-frequency oscillation) – high-frequency ventilation with a frequency 81 above 600 cycles/min” – HFOV sometimes uses frequency down to 7-8 Hz, that is, 420-480/min.
• Has been changed

 

• “From the point of view of the ventilation circuit closure to the atmosphere, HFV can be divided into closed (hermetic) and open (non-hermetic) systems.” – this sentence is difficult to understand. During neonatal HFOV via endotracheal tubes, there is usually a leak (not sealed) because uncuffed endotracheal tubes are usually used in babies.
• Now revised to be correct

 

• Table 1: “Advangegous” – typo
• corrected

 

• “A patient undergoing procedures that require a different way of securing the airways, or 240 the use of another interface between the ventilator and the patient is problematic or im- 241 possible. “ – something is missing from this sentence.
• sentence now corrected, also citation included

 

• “This area allows you to choose from multiple techniques/approaches and replace the rou- 243 tine procedure of conventional ventilation (CV) with C-HFJV.” – This reviewer does not understand what this sentence wants to say
• Sentence has been deleted for clarity as it lost meaning during an article editing and wasn’t removed before

 

• The “total stop: automatic shutdown system concept is only introduced towards the end of the paper and it needs more explanation.

 

• Is now introduced earlier in the article and better explained

 

• “Repeated insertion 268 of a Kleinsasser catheter can be avoided” – This term (Kleinsasser catheter )had not been mentioned before or explained
• Term needed to be corrected as the intended was Kleinsasser tube

Author Response File: Author Response.pdf

Reviewer 2 Report

The article reports catheter high-frequency jet ventilation and its basic technical and application principles. This article is easy to understand and fit the aim and scope of journal. However, there are some minor and major issues that need to be addressed prior to further decision:

Minor: The title needs to be corrected. The equation (which also includes the unit and symbols) in figure 1 should be corrected. Please include references for figures where necessary.

Major: Does the result section take into consideration of lung disease complications such as pneumonia, viral infection and COVID? Please elaborate these in the results section. The authors should explain how the catheter can eliminate the microorganisms from the patient (as mentioned by the authors in the conclusion section). Please ensure that the conclusion is well supported by the results written in this manuscript.

Need some correction or checking

Author Response

We thank the reviewer for most constructive comments, all have been implemented and corrected, as well as many sections rewritten for grammar and clarity. All changes are marked in red in the attached document arm-2406269.docx

Minor: The title needs to be corrected. – title revised

The equation (which also includes the unit and symbols) in figure 1 should be corrected. Please include references for figures where necessary.

• After thorough revision the authors decided, the equation is correct, references are now included

Major: Does the result section take into consideration of lung disease complications such as pneumonia, viral infection and COVID? Please elaborate these in the results section.

• The results section has been incorporated into conclusion, as for review article we changed the outline and the first paragraph now contains considerations for disease complications

The authors should explain how the catheter can eliminate the microorganisms from the patient (as mentioned by the authors in the conclusion section). Please ensure that the conclusion is well supported by the results written in this manuscript.

-this section has been revised

Author Response File: Author Response.pdf

Round 2

Reviewer 1 Report

Thank you for addressing my concerns. I have no further issues.

Reviewer 2 Report

I am happy with the corrections made by the authors.

Thus, I recommend for acceptance.

Need English checking.