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Death rattle

  • Vastgesteld: 16-07-2024
  • Regiehouder: Nederlandse Vereniging van Kindergeneeskunde (NVK)

Diagnostics of death rattle




 Consider
  • Consider establishing death rattle based on observations.
  • If in doubt, consider performing physical examination for further causes such as airway compression, corpus alienum, pulmonary oedema or pneumonia.
  • If in doubt, consider confirming mucous stasis by having the child cough or huff. Only if the child is still able to do so and this is not too burdensome.

General treatment of death rattle



 DO
  • Discuss before the terminal phase what death rattle is and explain to those involved that it is not uncomfortable for the child. Repeat this information at the time that the death rattle occurs.
  • Explain that the death rattle is a normal symptom in the dying process.
  • Repeat this information at the time the death rattle occurs.

Non-pharmacological treatment of death rattle

Suctioning


 DO NOT
  • Avoid suctioning in the case of death rattle in the terminal phase given the additional discomfort.

Body position

 Consider
  • Consider lateral position and adjusting head positions when feasible.

Reduce fluid intake

No
recommendation possible
  • Recommendations to adjust the amount of fluid administered to prevent death rattle or facilitate coughing cannot be given due to lack of evidence. There appears to be no reason to include death rattle as a factor in determining terminal fluid management.

Pharmacological treatment of death rattle

Anticholinergic agents


 Consider
  • Standard medication does not seem appropriate. Should relatives wish to do so, anticholinergic agents ((butyl)scopolamine, glycopyrronium, and atropine) may be considered.

Evaluation of death rattle


 DO
  • Evaluate the effect and side effects of the treatment instituted at the appropriate time, and adjust treatment as needed. Involve child and family in this process.