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Nobuyuki Watabe

Bio: Nobuyuki Watabe is an academic researcher. The author has contributed to research in topics: Community-acquired pneumonia & Pneumonia. The author has an hindex of 1, co-authored 1 publications receiving 312 citations.

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TL;DR: Scanning of the thorax demonstrated that 71% of patients aspirated, whereas aspiration was observed in only 10% of control subjects, which may indicate an important role of silent aspiration in the development of community-acquired pneumonia in the elderly.
Abstract: Pneumonia is a major cause of death in the elderly. To investigate the role of silent aspiration in community-acquired pneumonia, we examined the occurrence of silent aspiration during sleep in 14 elderly patients with acute episode of pneumonia and 10 age-matched control subjects by a new technique using indium111 chloride. Scanning of the thorax demonstrated that 71% of patients aspirated, whereas aspiration was observed in only 10% of control subjects. The percentage of positive scans was significantly higher in patients with acute episode of pneumonia than in control subjects (p < 0.02). The results may indicate an important role of silent aspiration in the development of community-acquired pneumonia in the elderly.

325 citations


Cited by
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TL;DR: Aspiration pneumonitis (Mendelson's syndrome), whereas aspiration pneumonia is an infectious process caused by the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria, are distinct clinical entities.
Abstract: Aspiration is defined as the inhalation of oropharyngeal or gastric contents into the larynx and lower respiratory tract.1,2 Several pulmonary syndromes may occur after aspiration, depending on the amount and nature of the aspirated material, the frequency of aspiration, and the host's response to the aspirated material.2 Aspiration pneumonitis (Mendelson's syndrome) is a chemical injury caused by the inhalation of sterile gastric contents, whereas aspiration pneumonia is an infectious process caused by the inhalation of oropharyngeal secretions that are colonized by pathogenic bacteria. Although there is some overlap between these syndromes, they are distinct clinical entities (Table 1). Other . . .

1,246 citations

Journal ArticleDOI
01 Oct 2009-Thorax
TL;DR: A summary of the initial management of patients admitted to hospital with suspected community acquired pneumonia (CAP) is presented and the relevant microbiological investigations and empirical antibiotic choices recommended in patients with CAP are summarized.
Abstract: A summary of the initial management of patients admitted to hospital with suspected community acquired pneumonia (CAP) is presented in fig 8. Tables 4 and 5, respectively, summarise (1) the relevant microbiological investigations and (2) empirical antibiotic choices recommended in patients with CAP. Figure 8 Hospital management of community acquired pneumonia (CAP) in the first 4 h. CXR, chest x ray; DBP, diastolic blood pressure; SBP, systolic blood pressure. View this table: Table 4 Recommendations for the microbiological investigation of community acquired pneumonia (CAP) View this table: Table 5 Initial empirical treatment regimens for community acquired pneumonia (CAP) in adults ### Investigations ( Section 5 ) #### When should a chest radiograph be performed in the community? 1. It is not necessary to perform a chest radiograph in patients with suspected CAP unless: 2. #### When should a chest radiograph be performed in hospital? 1. All patients admitted to hospital with suspected CAP should have a chest radiograph performed as soon as possible to confirm or refute the diagnosis. [D] The objective of any service should be for the chest radiograph to be performed in time for antibiotics to be administered within 4 h of presentation to hospital should the diagnosis of CAP be confirmed. #### When should the chest radiograph be repeated during recovery? 1. The chest radiograph need not be repeated prior to hospital discharge in those who have made a satisfactory clinical recovery from CAP. [D] 2. A chest radiograph should be arranged after about 6 weeks for all those patients who have persistence of symptoms or physical signs or who are at higher risk of underlying malignancy (especially smokers and those aged >50 years) whether or not they have been admitted to hospital. [D] 3. Further investigations which may include bronchoscopy should be considered in patients with persisting signs, symptoms …

1,204 citations

Journal ArticleDOI
01 Jul 2003-Chest
TL;DR: Elderly patients with clinical signs suggestive of dysphagia and/or who have CAP should be referred for a swallow evaluation and consideration for treatment with an angiotensin-converting enzyme inhibitor.

813 citations

Journal ArticleDOI
TL;DR: This work investigated whether oral care lowers the frequency of pneumonia in institutionalized older people and found that oral care improves the likelihood of avoiding pneumonia in these people.
Abstract: OBJECTIVES: Aspiration of oral secretions and their bacteria is increasingly being recognized as an important factor in pneumonia. We investigated whether oral care lowers the frequency of pneumonia in institutionalized older people. DESIGN: Survey. SETTING: Eleven nursing homes in Japan. PARTICIPANTS: Four hundred seventeen patients randomly assigned to an oral care group or a no oral care group. INTERVENTION: Nurses or caregivers cleaned the patients’ teeth by toothbrush after each meal. Swabbing with povidone iodine was additionally used in some cases. Dentists or dental hygienists provided professional care once a week. MEASUREMENTS: Pneumonia, febrile days, death from pneumonia, activities of daily living, and cognitive functions. RESULTS: During follow-up, pneumonia, febrile days, and death from pneumonia decreased significantly in patients with oral care. Oral care was beneficial in edentate and dentate patients. Activities of daily living and cognitive functions showed a tendency to improve with oral care. CONCLUSION: We suggest that oral care may be useful in preventing pneumonia in older patients in nursing homes. J Am Geriatr Soc 50:430‐433, 2002.

677 citations

Journal ArticleDOI
TL;DR: This review focuses on recent publications relative to CAP and NHAP in the very old, and discusses predisposing factors, microorganisms, diagnostic procedures, specific aspects of treatment, prevention, and ethical issues concerning end-of-life pneumonia.
Abstract: Pneumonia is a major medical problem in the very old. The increased frequency and severity of pneumonia in the elderly is largely explained by the ageing of organ systems (in particular the respiratory tract, immune system, and digestive tract) and the presence of comorbidities due to age-associated diseases. The most striking characteristic of pneumonia in the very old is its clinical presentation: falls and confusion are frequently encountered, while classic symptoms of pneumonia are often absent. Community-acquired pneumonia (CAP) and nursing-home acquired pneumonia (NHAP) have to be distinguished. Although there are no fundamental differences in pathophysiology and microbiology of the two entities, NHAP tends to be much more severe, because milder cases are not referred to the hospital, and residents of nursing homes often suffer from dementia, multiple comorbidities, and decreased functional status. The immune response decays with age, yet pneumococcal and influenza vaccines have their place for the prevention of pneumonia in the very old. Pneumonia in older individuals without terminal disease has to be distinguished from end-of-life pneumonia. In the latter setting, the attributable mortality of pneumonia is low and antibiotics have little effect on life expectancy and should be used only if they provide the best means to alleviate suffering. In this review, we focus on recent publications relative to CAP and NHAP in the very old, and discuss predisposing factors, microorganisms, diagnostic procedures, specific aspects of treatment, prevention, and ethical issues concerning end-of-life pneumonia.

402 citations