Defining and Managing End-of-Life Respiratory Changes in Adult Home Hospice Patients: A Systematic Review

Abstract

Background:

End-of-life respiratory changes—agonal breathing, Cheyne–Stokes breathing, and death rattle/noisy breathing—are common in home hospice settings, impacting patient comfort, caregiver distress, and quality of care.

Purpose:

To identify and critically evaluate literature on definitions, characteristics, and management for end-of-life respiratory changes in home hospice patients.

Data Sources:

English-language articles in Ovid Medline, Scopus, CINAHL, APA PsycINFO, and Web of Science published before April 18, 2024.

Study Selection:

9 peer-reviewed articles (comprising two nonrandomized experimental studies, two case reports, a cohort study, a cross-sectional study, a review, a text and opinion article, and a combined case report with personal reflection) involving adults in home hospice or palliative care and included definitions, characteristics, or treatments of agonal breathing, Cheyne–Stokes breathing, or death rattle/noisy breathing.

Data Extraction:

Two independent reviewers extracted data on study characteristics, respiratory change definitions/characteristics, distress to patients and care providers, and treatments.

Data Synthesis:

Most studies were recent (2014 or later) and conducted in the United States. Agonal breathing was defined as reflexive gasping and sighing respirations. Cheyne–Stoke’s breathing was mentioned without detailed descriptions. Death rattle/noisy breathing was characterized by loud secretions. Distress was evident for care providers, not patients. Treatment included anticholinergics for death rattle/noisy breathing, showing limited efficacy, and nonpharmacological approaches such as caregiver education and patient positioning.

Limitations:

Few studies included, encompassing various report types.

Conclusions:

There is a dearth of evidence on respiratory changes, particularly agonal breathing and Cheyne–Stokes breathing, in home hospice patients. Definitions and treatment guidelines vary, emphasizing the need for clear, evidence-based protocols. Improved caregiver education and future research are crucial to enhancing end-of-life care in home hospice settings.