Noisy Breathing / Death Rattle Assessment
Grades noisy breathing from retained secretions (death rattle) in dying patients with the Back scale (Back 2001) and guides management.
Score interpretation
→ Routine mouth care and positioning; reassess regularly.
→ Position: semi-prone or lateral; gentle oral care; reassure family; routine monitoring
→ Reposition (semi-prone or lateral); avoid suctioning (distressing, ineffective); explain to family: patient unlikely to be distressed despite noise. If an antimuscarinic is tried (NICE NG31; benefit is uncertain): Adults: Glycopyrronium 200mcg SC PRN, then Glycopyrronium 600-1200mcg/24h via CSCI; consider hyoscine hydrobromide if sedation also needed. Children: use a children's formulary. Review for dry mouth, urinary retention and agitation.
Interpretation bands for the Death Rattle / Secretions. Apply clinical judgement and local guidance.
References
Related
Curated clinical cross-links plus same-class fallbacks.
- Glycopyrrolate · Anticholinergic
- Glycopyrronium bromide · Antimuscarinic
- Neostigmine with glycopyrronium · Anticholinesterase + antimuscarinic
- Factor IX Concentrate · Coagulation Factor Replacement — Haemophilia B
- Beclometasone / Formoterol / Glycopyrronium · Triple Therapy ICS/LABA/LAMA — COPD
- Indacaterol / Glycopyrronium · LABA/LAMA Dual Bronchodilator — COPD
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.