One way of determining if the groaning or grunting you hear is related to distress at end of life is to observe if the sound is produced on exhalation. It is not unlike the sound of wind blowing through a group of trees on a stormy day. While grunting or groaning with increased work of breathing are cause for intervention in a person who is not at end of life, in the dying person these sounds are created by air being forced through relaxed vocal cords. Agonal gasping at the end of life is not a “desire or hunger for air” but rather a basic reflex of the dying brain.Īccessory muscles in the chest may be controlled by the brain steam at end of life, making breathing appear less coordinated, rapid, and labored, and can create a grunting or groaning sounds on exhalation. This means the breathing pattern is reflexive, and no longer a response to conscious awareness. Where once we had some conscious influence over our breathing (i.e., ability to willfully hold one’s breath), during end-of-life breathing is increasingly controlled by the dying brain stem. Agonal BreathingĪs the body is dying, respiration progressively becomes a solely involuntary act. When we understand this natural process does not cause discomfort or distress to the dying person, we are better able to provide symptom management and health teaching to support the patient’s loved ones. ![]() ![]() Becoming familiar with the normal changes that occur to breathing during dying helps all healthcare providers understand what they are witnessing is something we can expect. Healthcare providers and family members can be left with the memory that a person struggled to breathe as they died or worse, believed the reason the person died was because their lungs over-filled with fluid. ![]() At end of life there are few symptoms that gain one’s attention like the sound of noisy, gurgling breathing that can occur.
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