Preventief scopolaminebutyl kan reutelen in de stervensfase voorkomen

Objective

Death rattle is a common sign of dying. When non-pharmacological measures fail , the use of anticholinergic drugs to reduce death rattle is advised, although evidence regarding their efficacy is lacking. We studied prophylactic administration.

Design

A randomised, double-blind, placebo-controlled trial to evaluate the effect of prophylactic scopolamine butylbromide on the occurrence of death rattle.

Methods

Six hospices participated; at admission, patients were asked for advance consent to participate. Upon the recognition of the dying phase, patients were randomly allocated to receive subcutaneous scopolamine butylbromide (20 mg q.i.d.) or placebo. The primary outcome was the occurrence of death rattle grade ≥ 2 as defined by Back at two time points with a 4-hour interval. Secondary outcomes included the time between the recognition of the dying phase and the occurrence of death rattle, and anticholinergic adverse events.

Results

From April 2017 till December 2019, 1097 patients were admitted to the participating hospices. 635 patients were eligible and 229 gave written informed consent. We included 157 in the final intention-to-treat analyses. Death rattle occurred significantly less often in the scopolamine group (13%) compared to the placebo group (27%; p=0∙025); an analysis of the time to death rattle yielded a subdistribution hazard ratio (sHR) of 0∙44 (95% CI: 0∙20-0∙92; p=0∙031). The course of adverse events did not differ between the two groups.

Conclusion

Prophylactic scopolamine butylbromide can safely reduce the risk of death rattle.

Conflict of interest and financial support: potential conflicts of interest have been reported for this article. ICMJE forms provided by the authors are available online along with the full text of this article.