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

Mercadante, Sebastiano; Marinangeli, Franco; Masedu, Francesco; Valenti, Marco; Russo, Domenico; Ursini, Laura; Massici, Alessia; Aielli, Federica

doi:10.1016/j.jpainsymman.2018.08.018

Cited by 33 publications

(27 citation statements)

References 15 publications

(18 reference statements)

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“…Across all categories, the tool most frequently employed was the original Richmond Agitation-Sedation Scale (RASS) or its modified versions (n = 17). 10,21,35,51,[53][54][55]64,70,72,73,77,84,86,87,91,93 To assess level of consciousness Three of the ad hoc measures were modified versions of the existing tools: the Glasgow Coma Scale (GCS), 32,33 RASS 19,35 and Riker Sedation-Agitation Scale. 23,39 All other ad hoc measures comprised unique tools.…”

Section: Description Of Identified Measuresmentioning

confidence: 99%

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

et al. 2019

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Background: The use of observational measures to assess palliative care patients’ level of consciousness may improve patient care and comfort. However, there is limited knowledge regarding the validity and reliability of these measures in palliative care settings. Aim: To identify and evaluate the psychometric performance of observational level of consciousness measures used in palliative care. Design: Systematic review; PROSPERO registration: CRD42017073080. Data sources: We searched six databases until November 2018, using search terms combining subject headings and free-text terms. Psychometric performance for each identified tool was appraised independently by two reviewers following established criteria for developing and evaluating health outcome measures. Results: We found 35 different levels of consciousness tools used in 65 studies. Only seven studies reported information about psychometric performance of just eight tools. All other studies used either ad hoc measures for which no formal validation had been undertaken ( n = 21) or established tools mainly developed and validated in non-palliative care settings ( n = 37). The Consciousness Scale for Palliative Care and a modified version of the Richmond Agitation–Sedation Scale received the highest ratings in our appraisal, but, since psychometric evidence was limited, no tool could be assessed for all psychometric properties. Conclusion: An increasing number of studies in palliative care are using observational measures of level of consciousness. However, only a few of these tools have been tested for their psychometric performance in that context. Future research in this area should validate and/or refine the existing measures, rather than developing new tools.

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Section: Description Of Identified Measuresmentioning

confidence: 99%

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

et al. 2019

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“…Respiratory secretion, especially death rattle, and changes in respiratory patterns (eg, Cheyne-Stokes breathing and respiration with mandibular movement) are often seen during the last days of life 8 23 24. These may lead to distress in families; while clinicians have traditionally believed there is no patient distress caused by death rattle and changes in respiratory patterns developed in the context of declining consciousness, whether the patient perceives distress remains controversial 76–78…”

Section: Current Evidence Supporting Treatment For Terminal Breathlesmentioning

confidence: 99%

“…Anticholinergics have been used to reduce respiratory secretion; however, systematic reviews revealed no additional benefit of medications or non-pharmacological treatments compared with a placebo 79 80. A prophylactic use of anticholinergics has recently been proposed to prevent death rattle but such a suggestion is without sufficient evidence of benefit 77. Therefore, the evidence for pharmacological management to reduce secretions is controversial at present.…”

Section: Current Evidence Supporting Treatment For Terminal Breathlesmentioning

confidence: 99%

“…For example, a consensus definition of chronic breathlessness syndrome has widely raised recognition of this hidden discomfort, and led to a number of clinical trials with various treatment modalities 9 14–18. In addition, recent studies on terminal agitation and death rattle have demonstrated the feasibility of RCTs in patients during the last days of life, if appropriate strategies are implemented 22 77 82. Strategies include, but are not limited to, the use of advance or proxy consent, standardisation of care programmes, the application of short observation periods and the use of clinically implemented outcomes 22 75 82.…”

Section: Unanswered Research Questions In Terminal Breathlessnessmentioning

confidence: 99%

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Unanswered questions and future direction in the management of terminal breathlessness in patients with cancer

Mori

Yamaguchi²,

Matsuda

et al. 2020

ESMO Open

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Breathlessness is among the most common and deteriorating symptoms in patients with advanced cancer, which may worsen towards the end of life. Breathlessness in patients with estimated life expectancy of weeks to days has unique clinical features: it tends to worsen rapidly over days to hours as death approaches often despite current symptom control measures. Breathlessness in patients during the last weeks to days of life can be called ‘terminal breathlessness’. While evidence has accumulated for the management of breathlessness in patients with cancer who are not dying, such evidence may not be fully applied to terminal breathlessness. Only a few studies have investigated the best practice of terminal breathlessness in patients with cancer. In this paper, we summarise the current evidence for the management of terminal breathlessness, and propose future directions of clinical research.

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“…In a randomized controlled trial conducted in Belgium, the subcutaneous administration of atropine, scopolamine butylbromide, and scopolamine hydrobromide showed an improvement of approximately 40% on a pre-post basis; no significant difference between the drugs was reported [33]. Recently, the prophylactic administration of hyoscine butylbromide was shown to effectively prevent the death rattle [34]. However, because a randomized controlled study found that atropine was not superior to a placebo control, anticholinergic drugs are not widely recognized as the gold standard treatment [35].…”

Section: Increased Bronchial Secretionsmentioning

confidence: 99%

Communication with Families in the Last Days of a Patient’s Life and Optimal Delivery of a Death Pronouncement

Okamoto¹,

Uneno²,

Mori³

et al. 2019

Palliative Care

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Communicating with family members is critically important when a severely ill patient is experiencing their last few days of life. However, healthcare professionals (HCPs) have limited opportunities to learn effective and respectful ways to perform this communication. In recent decades, significant effort has been put forth to identify the phenomena that indicate the last hours and days of life and the optimal methods to deliver a death pronouncement, which will potentially help HCPs communicate compassionately with family members throughout the dying process. In this chapter, we will review the literature regarding the phenomena that indicate the last hours and days of life and the death pronouncement. Furthermore, we will discuss clinical implications derived from those articles and future research perspectives.

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

Cited by 33 publications

References 15 publications

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

Identification and evaluation of observational measures for the assessment and/or monitoring of level of consciousness in adult palliative care patients: A systematic review for I-CAN-CARE

Unanswered questions and future direction in the management of terminal breathlessness in patients with cancer

Communication with Families in the Last Days of a Patient’s Life and Optimal Delivery of a Death Pronouncement

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