Die Wirkung von Glycopyrroniumbromid im Vergleich mit Scopolamin-Hydrobromicum beim terminalen Rasseln: Eine randomisierte, doppelblinde Pilotstudie

Abstract

Glycopyrronium bromide given in a dose of 0,4 mg every six hours demonstrated a significant reduction of death rattle compared to scopolamine hydrobromide. Concerning side effects (restlessness, expressions of pain) there was no difference between both substances.

Off-Label Medication Use in the Inpatient Palliative Care Unit

“…Past studies differ in their support of glycopyrrolate over other anticholinergic medications such as scopolamine or atropine in reducing secretions (24-27). The largest multicenter study on death rattle treatment is a randomized prospective trial that found no difference in effectiveness among three anticholinergics – scopolamine, atropine, and hyoscine butylbromide (28).…”

Systematic review and narrative summary: Treatments for and risk factors associated with respiratory tract secretions (death rattle) in the dying adult

“…Likar et al. () found in favour of the intervention and Heisler et al. () found in favour of placebo, though neither results were statistically significant (Figure ).…”

“…The trials comparing an antimuscarinic drug to placebo balanced each other out. Likar et al (2008) found in favour of the intervention and Heisler et al (2013) found in favour of placebo, though neither results were statistically significant ( Figure 2). Furthermore, Hugel et al (2006) found glycopyrrolate superior to hyoscine, whereas Back et al (2001) found the opposite.…”

“…This tool is typically referred to as "Back's scale" after the first group to use it in 2001 for noise level assessment of death rattle (Back et al, 2001). In other publications, the researchers used their own 3 or 5-point scales for noise levels (Hughes et al, 2000;Likar et al, 2002Likar et al, , 2008 or 4-point scales for treatment effectiveness (Hugel et al, 2006).…”

“…None examined prophylactic treatment, even though treatment with Despite this knowledge, the entry criterion for all these trials was audible death rattle. An exclusion criterion was the simultaneous administration of antimuscarinic drugs for other conditions (Heisler et al, 2013;Likar et al, 2002Likar et al, , 2008Protus, Grauer, & Kimbrel, 2013). These studies reported that immediate effectiveness of treatments ranged from 27% to 86.4%, delayed effect from 33% to 76% and no effect from 22% to 58%.…”