SILENCE

Death rattle is defined as ‘noisy breathing caused by the presence of mucus in the upper respiratory tract’. This phenomenon is a common symptom in the last days of life, where 12–92% of patients in the dying phase have been reported to develop death rattle. Professionals assume that patients do not experience distress from death rattle because their consciousness is reduced in the dying phase.

For the relatives, the rattling noise is unpleasant and disturbing, and they may fear that their loved one is suffering and might be choking. Sixty-six percent of the relatives of patients who died in a palliative care unit indicated to experience death rattle as “very stressful” and 53% of them said that there is a great need to improve the care for and treatment of death rattle.

Anticholinergic medication is considered the standard treatment for death rattle. Anticholinergics decrease the production of mucus but do not affect existing mucus. These drugs may therefore be more effective if they are administered prophylactically, before death rattle occurs. Scopolaminebutyl is the most frequently prescribed anticholinergic drug for death rattle in the Netherlands.

We designed a randomized controlled trial (RCT) to answer our research question: is scopolaminebutyl, when given prophylactically, effective in preventing death rattle.A questionnaire will be sent to relatives three months after the patient has died to gain insight in how they experienced participation of their beloved one in research.

Collaborations within Erasmus MC

• Department of Public Health, research group: medical decisions in end-of-life care.

Collaborations outside of Erasmus MC

• Hospice unit “de Regenboog”
• Hospice Kuria
• Hospice Calando
• Hospice unit Cadenza
  

Van Esch HJ, Van Zuylen L, Oomen-de Hoop E, Van der Heide A, Van der Rijt CCD. Scopolaminebutyl given prophylactically for death rattle: study protocol of a randomized double-blind placebo-controlled trial in a frail patient population (the SILENCE study) BMC Palliat Care. 2018; 17: 105.

van Esch HJ, van Zuylen L, van der Rijt CCD. Prophylactic Scopolamine Butylbromide and Death Rattle in Patients at the End of Life-Reply. JAMA. 2022 Jan 18;327(3):285-286. doi: 10.1001/jama.2021.21863.

van Esch HJ, Prins SD, van de Vathorst S, van der Rijt CCD, van der Heide A, van Zuylen L. Reflections on Including Patients in a Randomized Placebo-Controlled Multicentre Trial in the Dying Phase - the SILENCE Study. J Pain Symptom Manage. 2021 Dec 23:S0885-3924(21)00675-8. doi: 10.1016/j.jpainsymman.2021.12.018.

van Esch HJ, van Zuylen L, Geijteman ECT, Oomen-de Hoop E, Huisman BAA, Noordzij-Nooteboom HS, Boogaard R, van der Heide A, van der Rijt CCD. Effect of Prophylactic Subcutaneous Scopolamine Butylbromide on Death Rattle in Patients at the End of Life: The SILENCE Randomized Clinical Trial.
JAMA. 2021 Oct 5;326(13):1268-1276. doi: 10.1001/jama.2021.14785.

van Esch HJ, Lokker ME, Rietjens J, van Zuylen L, van der Rijt CCD, van der Heide A. Understanding relatives' experience of death rattle. BMC Psychol. 2020 Jun 12;8(1):62. doi: 10.1186/s40359-020-00431-3.

• Carin van der Rijt
• Lia van Zuylen
• Agnes van der Heiden
• Jet van Esch