Terminal respiratory secretions (or simply terminal secretions), known colloquially as a death rattle, are sounds often produced by someone who is near death as a result of fluids such as saliva and bronchial secretions accumulating in the throat and upper chest. Those who are dying may lose their ability to swallow and may have increased production of bronchial secretions, resulting in such an accumulation. Usually, two or three days earlier, the symptoms of approaching death can be observed as saliva accumulates in the throat, making it very difficult to take even a spoonful of water. Related symptoms can include shortness of breath and rapid chest movement. While death rattle is a strong indication that someone is near death, it can also be produced by other problems that cause interference with the swallowing reflex, such as brain injuries.
This symptom most commonly appears sometime during the last 24 hours of the person's life, although some people live somewhat longer.
The dying person is usually unaware of the noisy breathing and is not disturbed by it, but some healthcare providers attempt to minimize the sound for the emotional comfort of family members and caregivers. This may be done through repositioning the person, reducing the volume of IV fluids being given, or giving anticholinergic drugs to reduce secretions. In hospice and palliative care, drugs such as glycopyrronium, hyoscine hydrobromide (scopolamine) or atropine may be used for their anticholinergic effects to reduce secretions and minimize this effect.
- Clinical Working Party (December 2010). "Guidelines for the management of respiratory secretions in an imminently dying patient" (PDF). Eastern Metropolitan Region Palliative Care Consortium (Victoria). Retrieved 13 April 2014.,
- Cobbs, Elizabeth L; et al. "When Death Is Near". MSD Manuals. MSD Manuals (Consumer Version). Retrieved 14 March 2016.
- Katherine Bickel; Robert Arnold MD. "# 109 Death Rattle and Oral Secretions, 2nd ed". Fast Facts. End-of-Life/Palliative Education Resource Center. Retrieved 4 September 2017.
- Wee, B.; Hillier, R. (2008). Wee, B. (ed.). "Interventions for noisy breathing in patients near to death". Cochrane Database of Systematic Reviews (1): CD005177. doi:10.1002/14651858.CD005177.pub2. PMID 18254072.
- Ferrell, Betty; Coyle, Nessa; Paice, Judith A. (2015). Oxford Textbook of Palliative Nursing (4th ed.). Oxford University Press. pp. 253–255. ISBN 9780199332342. OCLC 875629996.
- "When Death Is Near - Fundamentals - Merck Manuals Consumer Version". Merck Manuals Consumer Version. Retrieved 2017-06-24.
- Hipp, B.; Letizia, M. (2009). "Understanding and responding to the death rattle in dying patients". Medsurg Nursing. 18 (1): 17–21, 32, quiz 22. PMID 19331295.
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- East Tennessee State University - pulmonary breath sounds page with a death rattle sound clip