Death rattle
A death rattle is noisy breathing that often occurs in someone near death.[1] Accumulation of fluids such as saliva and bronchial secretions in the throat and upper airways is the cause.[2] Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation.[3] Usually, two or three days earlier, symptoms of approaching death can be observed, such as saliva accumulating in the throat, difficulty taking even a spoonful of water, shortness of breath, and rapid chest movement. While a death rattle is a strong indication that someone is near death,[2] it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.[3]
It is sometimes misinterpreted as the sound of the person choking to death or gargling. Notably, death rattle is a separate phenomenon from agonal respiration, ataxic respiration, and Kussmaul respiration.[4]
Timing
[edit]This symptom most commonly appears sometime during the last 24 hours of the person's life, although some live somewhat longer.[5]
Management
[edit]The dying person is usually unaware of the noisy breathing and is not disturbed by it, but some healthcare providers attempt to minimize the sound for the emotional comfort of family members and caregivers.[1] This may be done through repositioning the person, reducing the volume of IV fluids being given, or giving anticholinergic or anti-muscarinic drugs to reduce secretions, which have side effects.[6][5]
See also
[edit]References
[edit]- ^ a b Cobbs, Elizabeth L.; et al. "When Death Is Near". MSD Manuals Consumer Version. Merck. Retrieved 5 January 2024.
- ^ a b Wee, B.; Hillier, R. (2008). Wee, B. (ed.). "Interventions for noisy breathing in patients near to death". Cochrane Database of Systematic Reviews. 2017 (1): CD005177. doi:10.1002/14651858.CD005177.pub2. PMC 6478131. PMID 18254072.
- ^ a b Bickel, Kathleen; Kareem, Lava; Bui, Trinh; Arnold, Robert. "Death Rattle and Oral Secretions". Fast Facts. End-of-Life/Palliative Education Resource Center. Retrieved 4 September 2017.
- ^ Whited, Lacey; Hashmi, Muhammad F.; Graham, Derrel D. (2024), "Abnormal Respirations", StatPearls, Treasure Island (FL): StatPearls Publishing, PMID 29262235, retrieved 2024-11-10
- ^ a b Ferrell, Betty; Coyle, Nessa; Paice, Judith A. (2015). Oxford Textbook of Palliative Nursing (4th ed.). Oxford University Press. pp. 253–255. ISBN 9780199332342. OCLC 875629996.
- ^ Bennet, M (October 2002). "Using anti-muscarinic drugs in the management of death rattle: Evidence-based guidelines for palliative care". Palliative Medicine. 16 (5): 369–74 – via Pubmed.
External links
[edit]
- Pulmonary Breath Sounds, a page that includes a death rattle sound clip (published by East Tennessee State University)
