This labored breathing may amplify the death rattle. The death rattle is a sign that a person is approaching death. With each breath, a person may make a moaning, snoring, or rattling sound. The death rattle can sound like the person is choking.
However, no evidence suggests that the dying person is aware of the sound or experiences any related pain or unease. The death rattle is not painful. A nurse may do the following to ease the sound:. Proposed treatments are unlikely to prevent a death rattle, emphasizing that it is a natural stage of dying.
Medical professionals caring for a dying person will explain the noise to any loved ones present. Addressing the grief and needs of loved ones may help everyone to be more comfortable during the dying process. The noisy breathing can be distressing to family and other loved ones witnessing the death, but there is no evidence that the dying person experiences pain or discomfort.
Death anxiety is something that many of us may have felt to some degree, but how is it defined, what are its causes, and how is best to deal with it? Yes, I have a password. Remember me. Sign in. I would be happy to receive news and updates from Cancer Chat. Create new account. Leave this field blank.
Already a member? Sign in now. Not a member yet? Register now. Search for discussions or people. In January they gave us a few months. On Sunday, she fell asleep and hasn't woken up since.
W we got told a week left for her. Is this normal at the end? Her mouth is slack, her eyes slightly open but no movement. All we want to know is how long and do the symptoms fluctuate like this??? Advice please! Please keep us in the loop. There is always someone here for you whenever you feel like talking. I am thinking of and praying for you both. I am thinking of and praying for you all at this harrowing time. Kind regards, Jolamine xx.
It is unclear if treatment with medication is useful. The most fitting solution for this symptom is still under debate. A qualitative interview study with a phenomenological approach was performed. Data were collected through semi-structured interviews which were audio recorded, transcribed and analyzed using qualitative content analysis. Most relatives had experienced death rattle as a distressing symptom.
Concerns about how long the rattling would last resulted in more distress. Experience of death rattle was less fierce when other symptoms such as pain or dyspnea prevailed. Hearing the sound of death rattle sometimes reminded relatives of previously witnessed dying trajectories, which seemed to increase their current level of distress.
The experience of death rattle is not always influenced by the amount and quality of information given about the symptom. Death rattle is a stressful symptom and the experience of relatives is influenced by more factors than the sound itself. The best approach for dealing with this symptom is unclear. Further research needs to show if prophylactically given drugs may be helpful in its prevention. Peer Review reports. Death rattle is a common symptom in the dying phase which is caused by an accumulation of secretions in the upper airway [ 1 ].
This accumulation of fluid mucus cannot be easily coughed up or swallowed by the patient, often as a result of a diminished consciousness. A recently performed systematic review showed that approximately two thirds of dying patients present with this symptom [ 3 ]. This review also showed that health care professionals often assume patients are not distressed by the symptom since they are normally unconscious when death rattle develops.
However, insight into the impact of death rattle on patients remains unclear and can only be based on the subjective reports of others [ 3 ]. Experiences of relatives with death rattle have been studied previously [ 4 , 5 , 6 , 7 ]. Whether relatives experience distress seems to be related to their judgment as to whether a patient is comfortable. On the other hand for some relatives the symptom may be helpful, because it either demonstrates that the patient is still alive, or because it is seen as a sign of impending death and thus the end of the trajectory of suffering [ 5 , 6 ].
It is not known why relatives experience the symptom death rattle so differently. Nowadays, caregivers usually suggest that the patient is unconscious and therefore probably not suffering from the symptom. However, some authors suggested that this communication may cause relatives feeling themselves not acknowledged in their experiences [ 8 , 9 ].
A better understanding of the underlying causes of the various experiences may facilitate the support of relatives when death rattle occurs. The impact of death rattle on the relatives sometimes motivates physicians to start pharmacological treatment for this symptom, even though they assume that the patient is not bothered by it.
However, there still is no proven effective medical treatment for death rattle [ 9 , 10 , 11 ] and not all health care professionals support the view that drug therapy should be used for this symptom [ 12 ]. In order to be able to better support relatives in understanding and dealing with death rattle, it is important to get more insight into their experiences and in factors that influence these experiences.
Not only the sound itself, but also the burden of the dying trajectory for relatives and patients, information and communication, and previous experiences may influence how relatives value death rattle.
This study is part of a larger study focusing on hydration, death rattle and terminal restlessness in the dying phase. Details of this study, that was performed in 13 clinical sites, are described elsewhere [ 13 ].
The study involved four-hourly registration of the intensity of death rattle, for which the scoring scale as proposed by Back et al. These registration data were used to identify relatives of deceased patients in whom the symptom had been present during the last days or hours of life. We performed a qualitative semi-structured interview study using a phenomenological interpretive approach. By choosing for the phenomenological approach we aimed to explore the experiences of the relatives based on their own descriptions and terms, rather than by starting from theoretical preconceptions [ 15 ].
Relatives of patients who had died between 3 and 12 months prior to the moment of recruitment were recruited at the participating study sites. The doctor who had been most involved in caring for this patient was then asked to contact a relative by sending an information letter about the study.
If a relative did not respond to the letter within a month, the doctor sent a reminder. Relatives were asked to return a reply card, call the research team or send an email. Relatives who agreed to be interviewed were contacted by telephone by the researcher M. All interviews were held by M.
The following topics were explored using an interview guide see appendix 1 :. The experience of death rattle: the sound, the burden for relatives and patients, course and treatment.
All question in the interview guide were literally asked in every interview. For every topic there were also some prompt questions, which were optional and could be used to help the respondents in their narratives. Relatives were requested to sign an informed consent form before the start of the interview and for consent to audiotape the interviews. Relatives were informed that all information shared with the researcher was confidential and that all reports would be anonymous.
Relatives were offered the opportunity to be referred to their general practitioner or a palliative care counsellor for emotional support following the interview if needed. A few days after each interview the researcher contacted the relative by telephone to evaluate the interview and to assess how they were doing. Interviews were audiotaped and transcribed verbatim and anonymously.
Transcripts were analyzed using a template analysis method [ 16 ]. Next, they constructed a template version 0 with themes based on these initial codes. During this coding process, two new themes emerged in the following three interviews which were discussed by M. L and H. These themes appeared to occur in almost all of the following interviews. Therefore, it showed these themes were common for the respondents. The first interview was read again by H. The final template consisted of 13 themes.
All these themes were described in detail for analyzing. All authors agreed on this template. We approached relatives of 95 patients.
Of those, 19 relatives of 15 patients were willing to be interviewed. Relatives of 30 patients refused and those of another 50 patients did not respond to the information letter. Nineteen family members of 15 patients were interviewed between February and June All relatives choose to be interviewed at home.
We started the interview by asking for the experience of the relative of the disease trajectory of their loved one. Their narratives included comments about communication, information, quality of care by the healthcare professionals, symptoms and the dying phase. We then asked more in depth about the different experiences by literally following our interview guide. When the dying phase was discussed, we immersed ourselves in the symptom death rattle. During the interview, the relatives also revived the last phase of their loved one, often accompanied by melancholic emotions.
Support was offered after the interviews. The characteristics of the relatives who were interviewed and the patients are shown in Table 1. Nine patients had died in the hospital whereas six had died in an inpatient hospice. They were interviewed on average 9 months after the death of the patient. Most patients had been diagnosed with cancer. Their age at death varied from 55 to Most themes followed from the topics of the interview guide: the experience of death rattle, previous experiences of death rattle, information about the symptom death rattle and the burden for the patient.
They may also crack a joke, smile and interact as if they had never left. It heralds that death is imminent, but can offer people a last precious glimpse of the person they love. Many people and studies have also reported the dying apparently being visited by and having animated conversations with unseen people in the room. Sometimes they appear to be talking to a loved one who has long since died — a parent, partner, or sibling.
Sometimes it's a religious figure. But studies of this suggest that it is almost always a positive experience for the person who is dying; they begin to talk of journeying and being welcomed.
Perhaps less welcome — and equally as uncommon, occurring in around 1 to 2 per cent of deaths — is pre-terminal agitation. This could be as minor as someone plucking at the bed sheets, restlessness and fidgeting, but it can be as dramatic as someone who might be hours away from death running down a hospital corridor yelling and screaming. Death, when it comes, can sometimes be as simple as one last long exhalation with nothing following. The pulse stops, the skin may suddenly take on a waxy hue, and in the majority of situations, this is the moment when we begin to grieve.
Death can be shocking enough. But imagine if you had said your final goodbye, the last breath has come and gone, then the person who you thought was dead suddenly draws a gasp and twitches. They are generally viewed as a sign of death, and can happen after the heart has stopped beating. Another strange and disturbing reflex that has been observed after death is called the Lazarus reflex. People who have been declared brain dead and have had artificial ventilation turned off have been seen to raise their arms and lower them slowly, sometimes crossed across the chest, sometimes by their side.
Brain death may also be accompanied by other reflexes that are no more a sign of life than the jerk of your knee when it is tapped with a hammer. These include repetitive facial twitches, slow toe twitches and even the entire leg twitching.
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