What is the death rattle?
The death rattle is noisy breathing caused by saliva or secretions pooling when a dying person is too weak to clear their throat.
The death rattle is noisy breathing caused by saliva or secretions pooling when a dying person is too weak to clear their throat. Air moving through the fluid can make a rattling, gurgling, wet or snoring sound.
The sound can be upsetting for family. It often does not distress the dying person, especially if they are very sleepy or unconscious, but ask the care team to check if you are worried.
General information: This page gives general information for people in Australia. It cannot tell you exactly what is happening in one person's situation. If you have concerns about a symptom, medicine, treatment decision or change in someone's condition, contact their doctor, palliative care team, nurse or other treating health professional.
Why it happens
Near death, swallowing and coughing become weak. Saliva and fluid may collect in the back of the throat or upper airways. The person may not be able to swallow or cough it away.
palliAGED describes noisy breathing from pooled respiratory secretions as one of the common terminal phase symptoms in people who are dying.
Does it mean death is close?
The death rattle can be a sign that death may happen in hours or days, but timing is not exact. It should be read with other signs, such as reduced consciousness, changed breathing, less urine, cool or mottled skin, and poor swallowing.
Some people have noisy breathing that comes and goes. Some never have it.
What may help
Ask the team about positioning. Turning the person slightly to one side, raising the head of the bed, or adjusting pillows may reduce the sound for some people.
Mouth care should continue. Medicines may be used to dry secretions in some situations, but they can cause side effects such as dry mouth, urinary retention, sedation or agitation.
Deep suctioning can be uncomfortable and may cause distress. It is not always helpful.
How families can cope with the sound
The sound can make it feel as if the person is choking. Ask the team directly: "Do they look distressed, or is the sound more distressing for us?" This can help you know what care is needed.
If the person looks peaceful, calm presence, mouth care and positioning may be enough.
When to get help now
Contact the palliative care team, GP, nurse or aged care staff urgently if the person seems distressed, frightened, blue around the lips with distress, choking, gasping, or has sudden severe breathlessness.
Call 000 if this is sudden breathing distress in someone not expected to be dying, or if there is no end-of-life plan and you need emergency help.
You may also want to read
- Does the death rattle mean the person is choking?
- Can a dying person feel the secretions in their throat?
- Are they suffering when breathing becomes noisy, irregular or stops for periods?
- Why does a dying person's breathing suddenly change?