Death Rattle Is Not Associated with Patient Respiratory Distress: Is Pharmacologic Treatment Indicated?

Background: Studies examining the effectiveness of treatment in reducing the noises of death rattle have been conducted; however, the physical impact of death rattle on the patient experiencing the phenomenon has not been investigated. Treatments may be undertaken to appease family and staff but these treatments may be more burdensome than beneficial to the patient. Further, nonbeneficial treatments increase the cost of care. Objective: To determine if patients with naturally occurring death rattle experience respiratory distress. Design: A prospective, two-group observation study was conducted. Patients who were near death were stratified into those with and without death rattle. Setting/Subjects: Seventy-one dying patients were recruited from three palliative care and hospice settings. Patients were excluded if they had an artificial airway or if their clinical condition caused a secondary source of death rattle, identified as pseudo-death rattle. Measurements: Daily observations were made for death rattle intensity and respiratory distress along with use of antisecretory medications. Results: About half of the sample had no death rattle (55%).There were no differences in respiratory distress when patients with and without death rattle were compared (t=1.48, p=0.143). Death rattle intensity and respiratory distress were not correlated (r=-0.13, p=0.477). Few patients (17%) were medicated with antisecretory agents. Many (58%) patients receiving an antisecretory agent did not experience a reduction in death rattle. Conclusions: Respiratory distress was not associated with death rattle among patients who were near death. In many cases, antisecretory agents did not produce quiet breathing.