Interventions for death rattle in patients during the final days and hours of life: a scoping review

Abstract

Introduction: Rattle is a common sign in patients during the last days and hours of life, produced by the flow of air through secretions in the upper respiratory tract. Objective: To map the extent and nature of scientific production related to interventions used for the relief of rattle in palliative care patients during their final days and hours. Materials and Methods: A scoping review was conducted according to the Joanna Briggs Institute methodology. The research was carried out in the databases CINAHL Complete, MEDLINE with Full Text, and the grey literature in March 2023. The article selection process was performed by two researchers, with a third deciding in case of doubt. Results: Eleven articles were included, identifying pharmacological and non-pharmacological interventions for the relief of rattle. The most used drugs act on saliva production, including anticholinergics, diuretics, and opioids. Among the non-pharmacological interventions, mouth care, oropharyngeal secretion aspiration, and head positioning stand out. In alleviating this symptom, the focus should be on the person and their families, providing useful information about the causes of rattle and non-pharmacological measures to minimize it. Conclusion: Rattle is a common phenomenon associated with the imminent dying process. More research is needed in this area, especially concerning the development of non-pharmacological interventions and informing families to help them understand the causes of respiratory noise and the interventions to be carried out.