• Hildegard Kolb, Austyn Snowden, and Elaine Stevens.
• Roxburghe House, NHS Grampian, Aberdeen, UK.
• J Adv Nurs. 2018 Jul 1; 74 (7): 1446-1462.

AimTo identify effective treatments and risk factors associated with death rattle in adults at the end of life.BackgroundThe presence of noisy, pooled respiratory tract secretions is among the most common symptoms in dying patients around the world. It is unknown if "death rattle" distresses patients, but it can distress relatives and clinicians. Treatments appear unsatisfactory, so prophylaxis would be ideal if possible.DesignQuantitative systematic review and narrative summary following Cochrane Collaboration guidelines.Data SourcesCINAHL, MEDLINE, Health Source Nursing and Web of Science were searched for international literature in any language published from 1993 - 2016 using MeSH headings and iterative interchangeable terms for "death rattle".Review MethodsRandomized controlled trials were appraised using the Cochrane Collaboration's tool for assessing risk of bias. Non-randomized studies were assessed using ROBINS-I tool for assessing risk of bias in non-randomized studies of interventions. Instances of treatment and risk were extracted and relevant key findings extracted in line with Cochrane methods.ResultsFive randomized trials and 23 non-randomized studies were analysed. No pharmacological or non-pharmacological treatment was found superior to placebo. There was a weak association between lung or brain metastases and presence of death rattle, but otherwise inconsistent empirical support for a range of potential risk factors.ConclusionsClinicians have no clear evidence to follow in either treating death rattle or preventing it occurring. However, several risk factors look promising candidates for prospective analysis, so this review concludes with clear recommendations for further research.© 2018 John Wiley & Sons Ltd.

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