Death rattle

The Death Rattle refers to a specific sound produced by a dying individual due to the accumulation of secretions in the upper airways. This distinct respiratory noise, often described as a wet or gurgling sound, can be a disturbing manifestation of the dying process for family members and caregivers.

Overview

The death rattle is usually a symptom of the final stage of dying and occurs when the person is no longer able to swallow, clear the throat, or cough up secretions. This accumulation of mucus and saliva in the throat and airways produces a rattling or gurgling sound during breathing. It is not believed to cause discomfort to the patient, though it can be distressing for those in the patient's presence.

Causes and Mechanisms

• The principal cause of the death rattle is the inability to clear secretions from the back of the throat and the upper airways. This inability is commonly due to a decreased level of consciousness, weakness, or loss of the swallowing reflex as the body approaches death.
• Conditions such as pneumonia, lung cancer, and COPD may exacerbate the production of these secretions, leading to a louder or more frequent death rattle.

Management

• While the death rattle itself requires no treatment, steps can be taken to make the situation more comfortable for both the dying person and those around them. Care often focuses on minimizing the noise and the secretion of fluids.
• Anticholinergic drugs, such as scopolamine or atropine, may be used to reduce the production of secretions. Repositioning the person on their side can also assist in the drainage of fluids.
• It's important to note that the use of suction to remove secretions is generally not recommended, as it can cause discomfort and distress without providing significant benefits.

Prognosis

The onset of the death rattle is generally considered a sign that death is near, typically occurring in the last 24 hours of life. However, the specific timing can vary considerably between individuals.

Educational Importance

Understanding the death rattle is important for medical professionals to provide effective end-of-life care. Effective communication about the death rattle can help reassure and prepare families and caregivers for the dying process.

References

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• Wee B, Hillier R. Interventions for noisy breathing in patients near to death. Cochrane Database Syst Rev. 2008;(1):CD005177.
• Lokker ME, van Zuylen L, Veerbeek L, van der Rijt CC, van der Heide A. Prevalence, impact, and treatment of death rattle: a systematic review. J Pain Symptom Manage. 2014;47(1):105-122.

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