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Noisy breathing in the last days of life, often called the death rattle, distresses many families. Guidelines give a drug to dry the secretions only once the noise has started and is causing distress. In one Dutch trial, starting the drug as soon as dying was recognised halved how often the rattle appeared.
Current practice. NICE NG31 (2015) asks teams to reassure families, consider non-drug measures, and consider atropine, glycopyrronium or hyoscine only once noisy secretions are distressing the dying person; the Korean last-days guideline (2020) grades drug treatment C IIb. Neither recommends prevention.
The trial. SILENCE randomised 162 people in six Dutch hospices, at the point the dying phase was recognised, to subcutaneous scopolamine butylbromide 20 mg four times a day or placebo (157 analysed). A death rattle of grade 2 or more occurred in 13% against 27% (difference 14%, 95% CI 2% to 27%). Restlessness was 28% against 23%, dry mouth 10% against 15% and urinary retention 23% against 17% among those assessed. It is one trial, in hospices, of one drug.
The gap. No guideline read has adopted prophylaxis, and how often it is used has not been measured.
Shares Care of dying adults in the last days of life, Syringe pumps and subcutaneous syringe drivers, Early integrated palliative care.
Shares the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
Shares the tags protocol-upgrade, upgrade:promising.
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