[Death rattle : what is the appropriate management ?]

Death rattle is a key indicator of the dying phase. While it does not appear to cause discomfort for patients, it can distress relatives and caregivers. Management relies primarily on nonpharmacological measures, such as repositioning, fluid restriction, and oral care. Despite their frequent use, anticholinergics have not proven effective in treating death rattle. Their prophylactic use may reduce its incidence, but at the cost of potential adverse effects. Anticholinergics should therefore be limited to situations in which the death rattle causes significant distress for relatives or discomfort for the patient. Among the available agents, scopolamine butylbromide and glycopyrronium show a more favorable tolerance profile.