Death rattle: current experiences and non-pharmacological management-a narrative review

Death rattle (DR) is a common symptom in dying patients, caused by secretions in the upper airway. Experiences regarding DR differ among patients, relatives, and health professionals. However, evidence of patients', relatives', and health professionals' needs for DR management in order to improve their experiences is lacking. In addition, little is known about the actual effects of non-pharmacological interventions on DR intensity or DR-related distress. This narrative review aims to explore (I) the experiences and needs of patients, relatives, and health professionals regarding DR sound and its management; and (II) studies on non-pharmacological interventions in DR management.

Based on a PubMed literature search with the free-text term "death rattle", nine studies published in the last ten years were included.

No significant correlation between DR intensity and patients' respiratory distress could be found. Some relatives experience high levels of distress and express a need for DR care improvement. Health professionals are often influenced in their decision-making to intervene by external pressure or their need 'to do something'. Both repositioning and explaining DR to relatives are seen as useful first-line non-pharmacological interventions by health professionals. The severity of DR does not improve when suctioning is performed before starting anticholinergics.

Variation in DR-related experiences and needs exists among relatives and health professionals. More research is needed into the effectiveness of non-pharmacological interventions for DR management and the most suitable measurement tools to objectify DR-related outcomes.