title: Prevalence, impact, and treatment of death rattle: a systematic review.
abstract: BACKGROUND
  Death rattle, or respiratory tract secretion in the dying patient, is a common and potentially distressing symptom in dying patients. Health care professionals often struggle with this symptom because of the uncertainty about management.
  
  
  OBJECTIVE
  To give an overview of the current evidence on the prevalence of death rattle in dying patients, its impact on patients, relatives, and professional caregivers, and the effectiveness of interventions.
  
  
  METHODS
  We systematically searched the databases PubMed, Embase, CINAHL, PsychINFO, and Web of Science. English-language articles containing original data on the prevalence or impact of death rattle or on the effects of interventions were included.
  
  
  RESULTS
  We identified 39 articles, of which 29 reported on the prevalence of death rattle, eight on its impact, and 11 on the effectiveness of interventions. There is a wide variation in reported prevalence rates (12%-92%; weighted mean, 35%). Death rattle leads to distress in both relatives and professional caregivers, but its impact on patients is unclear. Different medication regimens have been studied, that is, scopolamine, glycopyrronium, hyoscine butylbromide, atropine, and/or octreotide. Only one study used a placebo group. There is no evidence that the use of any antimuscarinic drug is superior to no treatment.
  
  
  CONCLUSIONS
  Death rattle is a rather common symptom in dying patients, but it is doubtful if patients suffer from this symptom. Current literature does not support the standard use of antimuscarinic drugs in the treatment of death rattle.
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands; Department of Medical Oncology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands. Electronic address: m.lokker@erasmusmc.nl.
authors.forename: Martine E
authors.initials: ME
authors.lastname: Lokker
authors.affiliation: Department of Medical Oncology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Lia
authors.initials: L
authors.lastname: van Zuylen
authors.affiliation: Department of Medical Oncology, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Carin C D
authors.initials: CC
authors.lastname: van der Rijt
authors.affiliation: Department of Public Health, Erasmus MC, University Medical Centre, Rotterdam, The Netherlands.
authors.forename: Agnes
authors.initials: A
authors.lastname: van der Heide
mesh_terms: D006801:Humans; D018727:Muscarinic Antagonists / Q000627:therapeutic use; D015995:Prevalence; D020545:Respiratory Mucosa / Q000187:drug effects / Q000378:metabolism* / Q000503:physiopathology; D012135:Respiratory Sounds / Q000187:drug effects; D013727:Terminal Care / Q000379:methods*
chemical_list: D018727:Muscarinic Antagonists
keywords: Death rattle; dying; end-of-life care; palliative care; symptoms