PDF(Pubmed)
Abstract：
OBJECTIVE: Audible upper airway secretions (\"death rattle\") is a common problem in cancer patients at the end-of-life. However, there is little information about its clinical features.
METHODS: This is a secondary analysis of a cluster randomised trial of clinically-assisted hydration in cancer patients in the last days of life. Patients were assessed 4 hourly for end-of-life problems (including audible secretions), which were recorded as present or absent, excepting restlessness/agitation, which was scored using the modified Richmond Agitation and Sedation Scale. Patients were followed up until death.
RESULTS: 200 patients were recruited, and 186 patients died during the study period. Overall, 54.5% patients developed audible secretions at some point during the study, but only 34.5% patients had audible secretions at the time of death. The prevalence of audible secretions increased the closer to death, with a marked increase in the last 12-16 h of life (i.e. the prevalence of audible secretions was highest at the time of death). Of those with audible secretions at the time of death, 24 had had a previous episode that had resolved. Development of audible secretions was not associated with use of clinically-assisted hydration, but there was an association between audible secretions and restlessness/agitation, and audible secretions and pain. However, most patients with audible secretions were not restless/agitated, or in pain, when assessed.
CONCLUSIONS: Audible secretions (\"death rattle\") are common in cancer patients at the end-of-life, but their natural history is extremely variable, with some patients experiencing multiple episodes during the terminal phase (although not necessarily experiencing an episode at the time of death).
METHODS: This is a secondary analysis of a cluster randomised trial of clinically-assisted hydration in cancer patients in the last days of life. Patients were assessed 4 hourly for end-of-life problems (including audible secretions), which were recorded as present or absent, excepting restlessness/agitation, which was scored using the modified Richmond Agitation and Sedation Scale. Patients were followed up until death.
RESULTS: 200 patients were recruited, and 186 patients died during the study period. Overall, 54.5% patients developed audible secretions at some point during the study, but only 34.5% patients had audible secretions at the time of death. The prevalence of audible secretions increased the closer to death, with a marked increase in the last 12-16 h of life (i.e. the prevalence of audible secretions was highest at the time of death). Of those with audible secretions at the time of death, 24 had had a previous episode that had resolved. Development of audible secretions was not associated with use of clinically-assisted hydration, but there was an association between audible secretions and restlessness/agitation, and audible secretions and pain. However, most patients with audible secretions were not restless/agitated, or in pain, when assessed.
CONCLUSIONS: Audible secretions (\"death rattle\") are common in cancer patients at the end-of-life, but their natural history is extremely variable, with some patients experiencing multiple episodes during the terminal phase (although not necessarily experiencing an episode at the time of death).
摘要：
目的：上呼吸道有声分泌物（“死亡嘎嘎声”）是癌症患者临终时的常见问题。然而,关于其临床特征的信息很少。
方法：这是对癌症患者生命最后几天的临床辅助水合作用的整群随机试验的二次分析。每4小时对患者的临终问题（包括可听分泌物）进行评估。被记录为存在或不存在，除了不安/激动，使用改良的里士满激动和镇静量表进行评分。对患者进行随访直至死亡。
结果：招募了200名患者，186名患者在研究期间死亡。总的来说,54.5％的患者在研究期间的某个时候出现了可听见的分泌物，但只有34.5%的患者在死亡时有可听见的分泌物。可听见的分泌物的患病率越接近死亡，在生命的最后12-16小时显着增加（即死亡时可听分泌物的患病率最高）。那些在死亡时有声音分泌物的人，24之前的情节已经解决。听觉分泌物的发展与临床辅助水合作用的使用无关，但是声音分泌物和躁动/激动之间有联系，还有听得见的分泌物和疼痛.然而,大多数有声音分泌物的患者并不躁动/激动，或者在痛苦中，当评估。
结论：声音分泌物（“死亡嘎嘎声”）在癌症患者临终时很常见，但是他们的自然史变化很大，一些患者在终末期经历多次发作（尽管不一定在死亡时经历发作）。
方法：这是对癌症患者生命最后几天的临床辅助水合作用的整群随机试验的二次分析。每4小时对患者的临终问题（包括可听分泌物）进行评估。被记录为存在或不存在，除了不安/激动，使用改良的里士满激动和镇静量表进行评分。对患者进行随访直至死亡。
结果：招募了200名患者，186名患者在研究期间死亡。总的来说,54.5％的患者在研究期间的某个时候出现了可听见的分泌物，但只有34.5%的患者在死亡时有可听见的分泌物。可听见的分泌物的患病率越接近死亡，在生命的最后12-16小时显着增加（即死亡时可听分泌物的患病率最高）。那些在死亡时有声音分泌物的人，24之前的情节已经解决。听觉分泌物的发展与临床辅助水合作用的使用无关，但是声音分泌物和躁动/激动之间有联系，还有听得见的分泌物和疼痛.然而,大多数有声音分泌物的患者并不躁动/激动，或者在痛苦中，当评估。
结论：声音分泌物（“死亡嘎嘎声”）在癌症患者临终时很常见，但是他们的自然史变化很大，一些患者在终末期经历多次发作（尽管不一定在死亡时经历发作）。
