Title: Prophylactic endotracheal intubation prior to emergency endoscopy for acute
esophagogastric variceal hemorrhage: A retrospective single center study
Version: 1 Date: 14 May 2025
Reviewer's report:
Great idea for a study.
I have few comments:
1.  You showed that active bleed was associated with higher cardiopulm complication. PEI
groups has more patient requiring higher transfusion, which should be sign of active bleed. Is it
possible pna/pulm edema/taco were related to aspiration prior to the intubation due to high rate of
bleed and pulm edema was related to taco rather than mechanical ventilation, which should help
with edema and not cause it, especially when exercising positive pressure ventilation. Would
check for this cofounding.
2. Stats calculation seems to be little off. How can you meaningfully calculate p value in low N
of 97 with rare event of death with intubation ? lines: 195-198
3.Why are you excluding 3 cases of massive aspiration from non PEI group? It was decision
not to intubate initially and not rescue intubation which resulted in many cardiopulmonary
complication and ultimately cause certain LOS
4. Please check syntax, flow of text and wording. For example: line 226: i think you wanted
to say:
" patients intubated for more than 24 hrs" and not extubated. Some of the sentences  discussing
extubation within 24 hrs and after 24 hrs are confusing.
5. Finally, conclusion, recommendation may be little overstated. I think more correct statement
is that study does not allow you to recommend PEI before emergency endoscopy for patients
with AEVB to be performed routinely and decision to prophylactically intubate should stay on
case by case basis till more information is collected.
Probably the most robust data support statement that extubation within 24 hrs results in lesser
cardiopulmonary complication and shorter LOS .
Title: Prophylactic endotracheal intubation prior to emergency endoscopy for acute
esophagogastric variceal hemorrhage: A retrospective single center study
Version: 1 Date: 14 May 2025
Reviewer's report:
Great idea for a study.
I have few comments:
1.  You showed that active bleed was associated with higher cardiopulm complication. PEI
groups has more patient requiring higher transfusion, which should be sign of active bleed. Is it
possible pna/pulm edema/taco were related to aspiration prior to the intubation due to high rate of
bleed and pulm edema was related to taco rather than mechanical ventilation, which should help
with edema and not cause it, especially when exercising positive pressure ventilation. Would
check for this cofounding.
2. Stats calculation seems to be little off. How can you meaningfully calculate p value in low N
of 97 with rare event of death with intubation ? lines: 195-198
3.Why are you excluding 3 cases of massive aspiration from non PEI group? It was decision
not to intubate initially and not rescue intubation which resulted in many cardiopulmonary
complication and ultimately cause certain LOS
4. Please check syntax, flow of text and wording. For example: line 226: i think you wanted
to say:
" patients intubated for more than 24 hrs" and not extubated. Some of the sentences  discussing
extubation within 24 hrs and after 24 hrs are confusing.
5. Finally, conclusion, recommendation may be little overstated. I think more correct statement
is that study does not allow you to recommend PEI before emergency endoscopy for patients
with AEVB to be performed routinely and decision to prophylactically intubate should stay on
case by case basis till more information is collected.
Probably the most robust data support statement that extubation within 24 hrs results in lesser
cardiopulmonary complication and shorter LOS .
Please review this paper.
user
Title: Prophylactic endotracheal intubation prior to emergency endoscopy for acute
esophagogastric variceal hemorrhage: A retrospective single center study
Version: 1 Date: 14 May 2025
Reviewer's report:
Great idea for a study.
I have few comments:
1.  You showed that active bleed was associated with higher cardiopulm complication. PEI
groups has more patient requiring higher transfusion, which should be sign of active bleed. Is it
possible pna/pulm edema/taco were related to aspiration prior to the intubation due to high rate of
bleed and pulm edema was related to taco rather than mechanical ventilation, which should help
with edema and not cause it, especially when exercising positive pressure ventilation. Would
check for this cofounding.
2. Stats calculation seems to be little off. How can you meaningfully calculate p value in low N
of 97 with rare event of death with intubation ? lines: 195-198
3.Why are you excluding 3 cases of massive aspiration from non PEI group? It was decision
not to intubate initially and not rescue intubation which resulted in many cardiopulmonary
complication and ultimately cause certain LOS
4. Please check syntax, flow of text and wording. For example: line 226: i think you wanted
to say:
" patients intubated for more than 24 hrs" and not extubated. Some of the sentences  discussing
extubation within 24 hrs and after 24 hrs are confusing.
5. Finally, conclusion, recommendation may be little overstated. I think more correct statement
is that study does not allow you to recommend PEI before emergency endoscopy for patients
with AEVB to be performed routinely and decision to prophylactically intubate should stay on
case by case basis till more information is collected.
Probably the most robust data support statement that extubation within 24 hrs results in lesser
cardiopulmonary complication and shorter LOS .
assistant