Death rattle: An audit of hyoscine (scopolamine) use and review of management

Abstract

This study investigated the pattern and determinants of hyosine (scopolamine) use for death rattle by a retrospective analysis of 100 consecutive deaths in a 22-bed hospice. Patient diagnoses, duration of stay, and doses and route of administration of hyoscine used int he final 48 hr before death were recorded. One-half of the patients received hyoscine in some form during the dinal 24 hr before death. Patients whi were in the hospice for longer than 9 days and thise with cerebral malignancy were given the highest doses of hyoscine in the final 24 hr ( z = −2.558, P = 0.011, and z = −1.968, P = 0.048, respectively). response to hyoscine appears to be variable, and a distinction is proposed between death rattle due to saluvary secretions (type 1) and that due to bronchial secretions (type 2) to explain the observed patterns of use. It is likely that hyoscine is more efficacious in treating type 1 death rattle than it is in treating type 2 death rattle.