Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset

Daisuke Furukawa; Yoshitaka Yamanaka; Hajime Kasai; Takashi Urushibara; Tomokazu Ishiwata; Sachiyo Muranishi

doi:10.1371/journal.pone.0267119

Peer Review History

Original SubmissionJune 20, 2021
18 Oct 2021 Decision Letter - Muhammad Adrish, Editor PONE-D-21-20197Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onsetPLOS ONE Dear Dr. Furukawa, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: Please review comments made by the reviewers and provide point by point response in your revised manuscript. ============================== Please submit your revised manuscript by 18th November, 2021. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. 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The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf. 2. Please include captions for your Supporting Information files at the end of your manuscript, and update any in-text citations to match accordingly. Please see our Supporting Information guidelines for more information: http://journals.plos.org/plosone/s/supporting-information. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Furukawa et al in an interesting study analyze the temporal characteristics of aspiration pneumonia (AP) in the elderly inpatients after resumption of oral intake. The authors conclude that close observation for AP should be kept for 16 days after resuming oral intake. Fever observed after that oral eating resuming date might be due to non-AP or to an urinary tract infection (UTI). Obviously, in these febrile patients without AP, discontinuation of oral intake is useless , extended hospitalization stay and might be even harmful. The work presented here is certainly original in my opinion and brings forward the relevant issue of the timing of AP in hospitalized elderly patients that restart oral intake. This reviewer adds some minor points that perhaps might clarify some aspects of the manuscript: 1.How angiotensin-converting enzyme (ACE) inhibitors are associated with aspiration pneumonia (AP)?Could you discuss it briefly?(page 3, line 50) 2.What is the purpose of cervical auscultation ? Looking for stridor due to upper airways stenosis?Looking for pharingo-esophageal bubbling after oral intake? (page 5, line 104) 3.Fig.2 key description that AP do not develop later than 17 days after resuming oral intake lacks in the Results section although it appears in the Discussion Section as well as in the absctract. I would added it also to the Results section due to its importance. (page 11, line 187) Reviewer #2: Although the authors make an important finding of developing AP symptoms after resuming food intake has a smaller interval, the data is insufficient to support the conclusions. The result section is short and confusing. The authors make a point about how resumption of food intake could be leading to AP. However, they also say that onset of AP symptoms leads to the discontinuation of food intake in figure 3, which is not unusual. Hence, the purpose of figure 3 is unclear and difficult to interpret. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** VICTOR ASENSI Reviewer #2: No [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/. PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. 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Revision 1
21 Dec 2021 Author Response Reviewer #1: Furukawa et al in an interesting study analyze the temporal characteristics of aspiration pneumonia (AP) in the elderly inpatients after resumption of oral intake. The authors conclude that close observation for AP should be kept for 16 days after resuming oral intake. Fever observed after that oral eating resuming date might be due to non-AP or to an urinary tract infection (UTI). Obviously, in these febrile patients without AP, discontinuation of oral intake is useless, extended hospitalization stay and might be even harmful. The work presented here is certainly original in my opinion and brings forward the relevant issue of the timing of AP in hospitalized elderly patients that restart oral intake. This reviewer adds some minor points that perhaps might clarify some aspects of the manuscript: Thank you for all of your detailed comments and suggestions. We found them quite useful as we approached our revision. We are grateful for the time and energy you expended on our behalf. Comment 1: How angiotensin-converting enzyme (ACE) inhibitors are associated with aspiration pneumonia (AP)? Could you discuss it briefly? (page 3, line 50) Response: We agree with the reviewer's advice. ACE inhibitors are listed as a risk factor for AP but were not included in the analysis of this study. Therefore, we added the use of ACE inhibitors to the analysis. The result showed that the use of ACE inhibitors was very low (7 out of 114 patients) and not significantly different among the three infections. Thus, we have only described the results and not discussed the association. Proton pump inhibitors were also a point we had missed; we have now added them to our analysis. The results and changes are in Table 1, Measurements section (p.6, line 126) and Supporting information “S1 File”. Comment 2: What is the purpose of cervical auscultation? Looking for stridor due to upper airways stenosis? Looking for pharingo-esophageal bubbling after oral intake? (page 5, line 104) Response: Thanks for this suggestion. Per your comment, we have added the assessment procedure of cervical auscultation to the Definitions section (p.5, lines 105-108): “The cervical auscultation findings were compared with “clear” expiration before water was swallowed, and when breathing, sound wetness, stridor, coughing, throat clearing, or voice distortion was judged as “abnormal.”” Comment 3: Fig.2 key description that AP do not develop later than 17 days after resuming oral intake lacks in the Results section although it appears in the Discussion Section as well as in the absctract. I would added it also to the Results section due to its importance. (page 11, line 187) Response: Thanks for pointing this out. The following sentence was added to the Results section (p.7, lines 172-173) and figure 2 legend (p.9, lines 179-180): “AP did not develop later than 17 days after resuming oral intake.” Reviewer #2: Comment 1: Although the authors make an important finding of developing AP symptoms after resuming food intake has a smaller interval, the data is insufficient to support the conclusions. The result section is short and confusing. The authors make a point about how resumption of food intake could be leading to AP. However, they also say that onset of AP symptoms leads to the discontinuation of food intake in figure 3, which is not unusual. Hence, the purpose of figure 3 is unclear and difficult to interpret. Response: In Figure 3, we emphasized that AP was significantly more fasted than other infections; however, it was irrelevant to the discussion of this study. Thank you for identifying this inconsistency. We want to show that patients with infections other than AP were also unnecessarily fasting at fever after oral intake. Therefore, we have removed the description of significant differences from Figure 3 and the Results section. Furthermore, to emphasize the high discontinuation rate for infections other than AP, we have revised the following sentence in the Results section (p9, lines 186-187), the legend of Figure 3 (p.10, lines 191-192) and Discussion section (p,11, lines 199-200): “When both the non-AP and the UTI groups developed after resuming oral intake were combined, 42.5% of patients discontinued oral intake.” In addition, “about one quarter of patients" was changed to "about 40% of patients" in the Discussion section (p.11, line 215). Attachments Attachment Submitted filename: Response_to_Reviewers.docx https://doi.org/10.1371/journal.pone.0267119.r002
4 Apr 2022 Decision Letter - Shane Patman, Editor Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset PONE-D-21-20197R1 Dear Dr. Furukawa, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice for payment will follow shortly after the formal acceptance. To ensure an efficient process, please log into Editorial Manager at http://www.editorialmanager.com/pone/, click the 'Update My Information' link at the top of the page, and double check that your user information is up-to-date. If you have any billing related questions, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Shane Patman, PhD Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: I am pleased with the changes introduced in the revised version of the manuscript . The authors have adressed all the queries raised by this reviewer Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy. Reviewer #1: Yes:** VICTOR ASENSI Reviewer #2: No https://doi.org/10.1371/journal.pone.0267119.r003
Formally Accepted
6 Apr 2022 Acceptance Letter - Shane Patman, Editor PONE-D-21-20197R1 Temporal characteristics of aspiration pneumonia in elderly inpatients: From resumption of oral intake to onset Dear Dr. Furukawa: I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department. If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org. If we can help with anything else, please email us at plosone@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Assoc Prof Shane Patman Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0267119.r004

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