PhD defence Jet van Esch

Death rattle is a symptom of the dying phase. The sound is caused by the presence of mucus in the upper respiratory tract. The burden of death rattle for the patient is unknown, but the sound is disturbing for relatives and health care professionals.
Most of the studies described in this thesis were part of the research project ‘Death rattle in the dying phase: is prophylactic treatment useful?’, funded by the Netherlands Organisation for Health Research and Development (ZonMw). In this project we tried to understand the underlying causes of the various experiences of death rattle of bereaved relatives, studied the effect of prophylactically administered scopolamine butylbromide (medication that diminishes mucus) on the occurrence of death rattle, and assessed how a randomized, double-blind placebo-controlled trial in the dying phase can be feasible.

We found that death rattle can be a stressful symptom for relatives that is influenced by more factors than the intensity of the sound alone. Adequate information and communication cannot always relieve the burden for relatives. We showed that prophylactic subcutaneous scopolamine butylbromide significantly reduced the occurrence of death rattle in a hospice population. We found that the robust design and strategies to facilitate patient recruitment have resulted in a successful study with sufficient participants. According to relatives, patients’ participation in a double-blind placebo-controlled medication trial at the end of life need not be burdensome and does not interfere with the dying process.
The results are at this moment implemented in the guideline “Care in the dying phase”.