Problem and management of noisy rattling breathing in dying patients

Watts, Tessa; Jenkins, Kathleen; Back, Ian

doi:10.12968/ijpn.1997.3.5.245

Cited by 19 publications

(23 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is the first formal study of the impact of death rattle on hospice staff and volunteers apart from an earlier survey into hospice nurses' views. 4 Despite its limitations, this study has thrown up useful insights. It has confirmed that many hospice staff and volunteers are affected by the sound of death rattle.…”

Section: Implications For Practicementioning

confidence: 94%

See 1 more Smart Citation

Death rattle: its impact on staff and volunteers in palliative care

et al. 2008

View full text Add to dashboard Cite

show abstract

Section: Implications For Practicementioning

confidence: 94%

“…4 These nurses strongly believed that death rattle caused distress to relatives but less so to themselves and the patients.…”

Section: Introductionmentioning

confidence: 99%

Death rattle: its impact on staff and volunteers in palliative care

et al. 2008

View full text Add to dashboard Cite

show abstract

“…28 Yet there may be a potential for physical and psychological morbidity in Journal of Hospice & Palliative Nursing www.jhpn.com family members who witness this or other symptoms that could be equated with a ''bad death.'' 30 Given the uncertainty surrounding the effectiveness of pharmacological interventions and the presumed suffering of family members, the literature on death rattle frequently emphasizes the importance of communication. 1,2,6,20 This presumed distress may have more to do with the impending loss of a loved one than the sound of death rattle itself; if so, then the role of communication in addressing potential suffering takes on even greater importance.…”

Section: Impact On Families and Caregiversmentioning

confidence: 99%

“…1,2,6,20 This presumed distress may have more to do with the impending loss of a loved one than the sound of death rattle itself; if so, then the role of communication in addressing potential suffering takes on even greater importance. 30 Sensitive communication and time simply spent with family members are likely to be the most effective intervention for death rattle. 1,3,28 Case Study Conclusion…”

Section: Impact On Families and Caregiversmentioning

confidence: 99%

The Death Rattle Dilemma

Fielding¹,

Long²

2014

Journal of Hospice & Palliative Nursing

View full text Add to dashboard Cite

Death rattle, defined as the noise created by the flow of air through secretions in the upper respiratory tract, is a well-known phenomenon associated with the dying process. The use of anticholinergics is standard practice in hospice and palliative care, yet despite a growing number of quality clinical trials, there is still no compelling scientific evidence that our interventions for death rattle are effective. Studies to date have focused on antisecretory agents, primarily anticholinergics, with mixed results and variable interpretations. Recent placebo-controlled data suggest that death rattle may tend to diminish over time without medication. Objective measurements of patient distress indicate that dying patients experience very low levels of respiratory distress with or without death rattle. While treatment is often initiated based on the perceived distress of family members, emerging qualitative data suggest that death rattle is not always distressing to family and caregivers. Our current approach to death rattle presents a clinical and ethical dilemma; a better understanding of the range of responses and interpretations will allow nurses to frame the discussion of death rattle more effectively and help to guide care. More research is needed into nonpharmacologic, particularly communication-based, interventions for death rattle. KEYWORDSanticholinergic, communication, death rattle, dying, symptom management Case StudyMr E. was 66 years old with advanced gastric lymphoma and was dying at home, being cared for by his family. He was somnolent, but his respirations were unlabored, and lung sounds were clear. The hospice nurse educated his family on the signs and symptoms of active dying and the use of comfort medications, including 1% atropine eye drops to be given sublingually as needed for respiratory secretions. SIGNIFICANCEAlternately referred to in the literature as terminal congestion, retained secretions, noisy breathing, and respiratory tract secretions, death rattle is well known as a phenomenon associated with the dying process. Although the term death rattle may seem macabre, it is a pragmatic expression for a common occurrence at end of life and has the advantage of being both descriptive and widely recognizable. The varied terminology reflects a divergent body of research, the cumulative results of which have yet to define a criterion standard of treatment. This is due in part not only to inconsistent terminology, but also to the variable quality and conflicting findings between studies. 1 Despite barriers to research in dying patients, there is growing evidence to suggest a lack of utility of our treatments for death rattle. 2-6 This is especially important in light of research indicating that treatment is often given to alleviate the distress of family and caregivers, including health care professionals, while those who hear it are not always distressed by the sound. 7,8 In fact, objective measures indicate low levels of respiratory distress in dying patients and no difference in distress betwee...

show abstract

“…5 The administration of anticholinergic treatment for death rattle has often been justified as an intervention of benefit to the professional carers, relatives or even to other patients rather than the patients themselves. 6,7 However, Wee et al 8,9 reported that although some relatives considered the sound of death rattle distressing, this finding was not universal. One qualitative study using focus groups with health-care professionals provided evidence that some external influences are recognised by prescribers in their therapeutic decision-making to treat death rattle.…”

Section: Introductionmentioning

confidence: 99%