death rattle

Etiology

• inability to clear secretions from the oropharynx at the end-of-life

Pathology

• secretions oscillate up & down the respiratory tract during inspiration & expiration
• no indication that this causes distress for patients

Clinical manifestations

• noisy or rattling respirations at the end-of-life

Complications

• often results in anxiety for the family & caregiver(s)

Management

• prepare family, reassurance, anticipatory guidance
• repositioning may allow secretions to drain
• mouth hygeine with sponge swab may be helpful
• anticholinergics to reduce secretions
  • of benefit only when secretions affect respiration
  • atropine eyedrops under the tongue every 2 hours to reduce secretions (treatment of choice)
  • scopalamine patch (onset of action ~24 hours)
  • scopalmine 20 mg SQ QID prophylaxis
  • hyoscyamine 0.125 mg SL every 8 hours
  • glycopyrrolate 0.2 mg SQ every 8 hours
• oral suction probably not useful
  • avoid suctioning with catheter
  • avoid oropharyngeal suction as this results in unnecessary discomfort
  • anticholinergics do not dry up secretions already present

More general terms

• noisy rattle

Additional terms

• end of life