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

Sebastiano Mercadante, Franco Marinangeli, Francesco Masedu, Marco Valenti, Domenico Russo, Laura Ursini, Alessia Massici, and Federica Aielli
J Pain Symptom Manage. 2018 Dec;56(6):902-907

This open-label study compared the use of hyoscine butylbromide prophylactically in dying patients with a reduced level of consciousness (n=51) versus giving hyoscine butylbromide to dying patients only once they developed noisy respiratory tract secretions (n=81). Patients were administered 20mg of hyoscine butylbromide as a subcutaneous or intravenously bolus, followed by 60 mg/24 hours. In patients who were given prophylactic hyoscine butylbromide, 5.9% developed death rattle whilst 60.5% had death rattle in the group who were given hyoscine butylbromide once death rattle was established. There was a significant difference for the onset of death rattle in both groups (median time 12 hours vs 36 hours in the prophylactic group, P=0.0001). Side effects were not reported. The authors suggest that future studies consider a placebo-controlled trial with pre-emptive administration of hyoscine butylbromide may be useful to confirm the results of this exploratory study.

Composed by Elaine Boland.