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Empfehlung bei Rasselatmung

Recommendations for death rattle

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Zusammenfassung

Die geräuschvolle Atmung in den letzten Stunden oder Tagen des Lebens (Rasselatmung) gehört zu den häufigsten und am schwierigsten zu behandelnden Symptomen. In der Palliativmedizin liegen zur Therapie des Atemwegrasselns in der finalen Phase bislang noch keine anerkannten Richtlinien vor. Im vorliegenden Artikel wird zunächst die Rasselatmung beschrieben. Der zweite Teil gibt eine systematische Literaturübersicht zur Effektivität von Interventionen bei Rasselatmung. Zwei Datenbanken (Embase und Medline) wurden bis 2010 recherchiert. Nur 6 von 134 identifizierten Studien (2 Kohorten- und 4 experimentelle Studien), in denen Scopolamin, Glycopyrrolat, Butylscopolamin, Atropin und Octreotid getestet wurden, erfüllten die Einschlusskriterien. Es gibt wenige aussagekräftige Studien, die die Effektivität einer Behandlung bei Rasselatmung untersucht haben. Die gefundenen Studien zeigten methodologische Probleme. Nach wie vor wird eine nichtmedikamentöse Therapie als erste Wahl empfohlen. Falls Anticholinergika in Betracht gezogen werden, ist die Auswahl davon abhängig, ob gleichzeitig eine Sedierung erwünscht ist.

Abstract

Noisy breathing during the terminal stages of life (death rattle) is one of the most common and most difficult symptoms to treat. In palliative medicine there are still no accepted guidelines for the treatment of death rattle in the final phase of life. In the first part of this article a description of death rattle is presented and in the second part a systematic literature review gives an insight into the effectiveness of interventions for death rattle. Two databases (Embase and Medline) were searched up to 2010 which identified 134 studies but only 6 met the inclusion criteria (2 cohort and 4 experimental studies) in which scopolamine, glycopyrrolate, butyl scopolamine, atropine and octreotide were tested. There is a lack of conclusive studies which investigated the effectiveness of treatment of death rattle. Furthermore, the identified studies revealed methodical problems. In general non-drug therapy is recommended as first choice. If anticholinergics are considered the selection also depends on whether simultaneous sedation is desired or not. The English full text version of this article will be available in SpringerLink as of November 2012 (under “Supplemental”).

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Danksagung

Der Studentin Anne Pollok danken wir für ihre Unterstützung und den Gutachtern für die hilfreichen Kommentare.

Interessenkonflikt

Die korrespondierende Autorin gibt für sich und ihre Koautoren an, dass kein Interessenkonflikt besteht.

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  1. Klinik für Palliativmedizin, Klinikum der RWTH Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland

    T. Pastrana, H. Reineke-Bracke & F. Elsner

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  1. T. Pastrana
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  2. H. Reineke-Bracke
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  3. F. Elsner
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Correspondence to T. Pastrana.

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Pastrana, T., Reineke-Bracke, H. & Elsner, F. Empfehlung bei Rasselatmung. Schmerz 26, 600–608 (2012). https://doi.org/10.1007/s00482-012-1215-8

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