Hyoscine Butylbromide for the Management of Death Rattle: Sooner Rather Than Later

Journal of Pain and Symptom Management
Sebastiano MercadanteFederica Aielli

Abstract

Death rattle (DR) is a dramatic sign in the dying patient. Existing studies with anticholinergic agents are controversial, as this class of drugs has been commonly administered without considering the rationale of the mechanism of action. A meaningful use of these drugs may provide a better outcome. The aim of this study was to assess the efficacy of hyoscine butylbromide (HB), given prophylactically in comparison with HB administered once DR occurs. Dying patients having a score of ≥3 in the Richmond Agitation-Sedation Scale-palliative version were included in the study. HB (60 mg/day) was given when DR occurred (Group 1) or as pre-emptive treatment (Group 2). The onset of DR (death rattle free time) and intensity of DR were recorded at intervals until death. Eighty-one and 51 patients were randomized to Group 1 and 2, respectively. Patients in Group 2 survived longer than those in Group 1 (P < 0.05). DR occurred in 49 (60.5%) and three patients (5.9%) in Group 1 and 2, respectively (P = 0.001). A significant difference in the number of patients reporting DR was found at intervals examined (30 minutes, one hour, and then every six hours until death [P = 0.001]). In Group 1 and 2, DR free time was 20.4 (20.5) and 27.3 hours (25...Continue Reading

References

May 9, 2002·Journal of Pain and Symptom Management·Hans Wildiers, Johan Menten
Oct 17, 2002·Palliative Medicine·Mike BennettUNKNOWN Association for Palliative Medicine's Science Committee
Jun 13, 2006·Palliative Medicine·B L WeeS H Holgate
Dec 2, 2008·Journal of Pain and Symptom Management·Sebastiano MercadanteAlessandra Casuccio
Dec 7, 2010·Journal of Pain and Symptom Management·Sebastiano MercadantePatrizia Ferrera
May 31, 2011·Journal of Pain and Symptom Management·Sebastiano MercadanteUNKNOWN Home Care—Italy (HOCAI) Group
Jun 25, 2013·Journal of Pain and Symptom Management·Martine E LokkerAgnes van der Heide
Nov 21, 2013·Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer·Sebastiano Mercadamte
Apr 25, 2014·The Oncologist·David HuiEduardo Bruera

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Citations

Oct 1, 2019·Current Opinion in Supportive and Palliative Care·Tessa WattsBridget Johnston
May 16, 2019·BMJ Supportive & Palliative Care·Jason W Boland, Elaine G Boland
Jun 14, 2020·BMC Psychology·Harriëtte J van EschAgnes van der Heide
Feb 19, 2021·BMJ Supportive & Palliative Care·Sebastiano MercadanteFabrizio David
Oct 6, 2021·JAMA : the Journal of the American Medical Association·Jared R Lowe, Laura C Hanson
Oct 6, 2021·JAMA : the Journal of the American Medical Association·Harriëtte J van EschCarin C D van der Rijt
Sep 25, 2018·Journal of Pain and Symptom Management·Margaret L Campbell
Oct 28, 2018·Journal of Pain and Symptom Management·Katherine ClarkDavid C Currow

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