Death rattle

With rattle breathing, Präfinales rattles or death rattles (English: death rattle ) the noisy breathing of the dying in the last hours or days is called before death. A limitation of fluid intake can possibly shorten the duration of the rattle breathing.

The sound is caused by the fact that the persons concerned are no longer able to swallow saliva or mucus hochzuräuspern reflex or cough up. This in turn causes a loose obstruction ( narrowing ) in the airways ( from Glottisbereich to the main bronchus). In addition, the flaccid pharyngeal walls can strike with the respiratory flow together and be responsible for this noise with.

Rattle breathing of the dying as a rule not as dyspnea (shortness of breath ) and are therefore not perceived as stressful and can be observed both in awake, as well as in a coma patient is lying down. Members sometimes believe, to recognize the evidence of complaints and inaction of the doctor in a prolonged rattle breathing. An appropriate, tactful explanation is helpful in most cases. Since rattle breathing may charge as an indication of an early death fellow patients present much that is one reason why the dying are brought into hospitals usually in single rooms.

Pathophysiology

The secretion of saliva or mucus is made by the salivary glands and the bronchial mucosa. The loss of swallowing and cough reflex causes an accumulation of secretions in the throat ( oropharynx ) and bronchi.

Manifestations

After Bennett There are two types of rattle breathing.

Type I

Type I of the rattle breathing caused by an increased secretion of saliva in the last hours of an unconscious or bewusstseinsgetrübten patients. The loss of the swallowing reflex occurs suddenly. This form of rattle breathing is characterized by a better response to anticholinergics.

Type II

Type II of the rattle breathing is characterized by a predominantly bronchial mucus secretion, which is formed over several days. The patient is awake and is due to the increasing weakness no longer able to effectively cough. The probability of pneumonia (CAP ) is very large. The greater the temporal distance between the inability of the expectoration and the decease, the more likely the type II developed

Frequency

The rattle breathing is the most commonly observed symptom during the last hours in the life of a human being. Approximately 56-92 % of the people dying to get into this phase rattle breathing.

Indication

While the dying phase is described with dehydration ( dehydration by fluid deficiency and as a result, less secretion and rattle breathing) as not painful, sometimes the loud death rattle creates the appearance of an agonizing death throes. As a result of palliative medical perspective often objective signs of stress that require a corresponding symptom control or treatment.

The death rattle is an unpleasant for the family members and caregivers noise (increasing the overall stress situation).

Treatment

It was tried very early to prevent aspiration of mucus by the death rattles. This measure, however, is useless and causes more harm than good because of the suction catheter as not reaching lower in the mouth or throat and the secretion is located in the trachea or bronchi may not be achieved. Therefore, a suction catheter only leads to an increased production of secretions and can frequently trigger additional bleeding. Thus, it is important to explain to the families that the rattle breathing is a typical symptom of the final stage and the patient in this case generally has no shortness of breath.

The subcutaneous administration of scopolamine is suggested by some authors as treatment and frequently performed that way. The results of two studies are related to the efficiency, however, contradictory. At least for the type I of the rattle breathing seems to be rather doubtful efficacy. Glycopyrronium bromide causes obviously a significantly greater reduction in the death rattle as scopolamine.