The breathing pattern that is commonly seen in the final hours and minutes before death is called terminal respiration or terminal breathing. It is characterized by irregular, shallow breaths with long pauses in between. This breathing pattern indicates that death is imminent and marks the end stage of life. Understanding the signs and causes of terminal breathing can help caregivers provide comfort care in a person’s final moments.
What Does Terminal Breathing Look Like?
Terminal breathing has several distinctive characteristics:
- Breaths become irregular and sporadic
- There are long pauses of up to 40 seconds or more between breaths
- Breaths become shallow and ragged
- Breathing may speed up, then slow down
- Congestion can cause loud, raspy breathing sounds known as a “death rattle”
- Mouth may be open with jaw slack and tongue protruding
- Color changes as oxygen levels decrease, with lips, ears, fingers turning blue or purple
As death nears, the pauses between breaths become longer until breathing ceases altogether. The length and nature of the terminal breathing phase varies from person to person, but typically lasts from several minutes up to a few hours.
What Causes Terminal Breathing?
Terminal breathing is caused by the slowing down and shutting off of body systems as death approaches. Specifically:
- The respiratory center in the brain starts to fail, causing breathing to become irregular.
- The heart rate slows and blood circulation drops, depriving the brain and lungs of oxygen.
- Fluids may build up in the airways as the cough reflex decreases.
- Metabolic changes cause the body to retain carbon dioxide, creating the urge to breathe more deeply.
As oxygen levels drop and carbon dioxide builds up, the respiratory center triggers the gasping, labored breaths characteristic of terminal respiration. The short, ineffective breaths are the body’s last attempts to get oxygen before breathing stops completely.
When Does Terminal Breathing Occur?
Terminal breathing most often occurs in the final days, hours or minutes of life. The exact timing depends on the individual and the disease progression:
- In cancer – Hours to days before death
- In organ failure – Days to weeks before death
- In frail elderly – Weeks to months before death
- In sudden events like trauma or heart attack – Minutes before death
Certain signs may indicate when terminal breathing is about to start, such as:
- Profound weakness and inability to awaken
- Little to no interest in food or fluids
- Difficulty swallowing or inability to take oral medications
- Surge of energy or rally of alertness before a sudden decline
Caregivers should watch for these signals that indicate death is likely within hours to days. When terminal breathing begins, it means the person is likely within minutes to hours of passing away.
Comfort Care During Terminal Breathing
It can be distressing for loved ones to witness terminal breathing. However, there are ways to provide comfort during this transition:
- Speak in a soothing tone and lightly touch or hold the person’s hand to provide reassurance.
- Keep them warm with blankets to prevent shivering.
- Use pillows to keep them positioned upright to aid breathing.
- Ensure privacy and quiet.
- Moisten their lips with swabs or apply lip balm to prevent drying.
- Use a cool mist humidifier or oxygen if available.
- Administer any prescribed comfort medications, such as morphine.
The goal is to ease any pain or restlessness and help the person pass as peacefully as possible. It’s also important for family to have spiritual support and reassurance that terminal breathing is normal and expected.
Can Terminal Breathing Be Prevented?
Terminal breathing cannot be prevented when a person is dying from irreversible conditions and organ failure. As death nears, the changes that trigger terminal respiration will inevitably occur.
However, the following can help reduce discomfort during terminal breathing:
- Medications – Opioids like morphine can relax breathing muscles and decrease airway congestion.
- Oxygen – Oxygen therapy may aid labored breathing but should be used sparingly in actively dying patients.
- Positioning – Elevating the upper body can ease work of breathing.
- Suctioning – Gentle oral suctioning can remove excess secretions.
- Hydration – Ice chips and lip moisturizer can prevent drying.
While these can help, the focus should be on comfort rather than artificially prolonging or hastening dying. Terminal breathing generally can’t be altered but should be allowed to occur naturally.
Conclusion
Terminal respiration, or terminal breathing, refers to the irregular, labored breathing pattern that precedes death. It is caused by multiple organ failure and indicates the body’s last attempts to get oxygen. While it can’t be prevented, caregivers can provide comfort by easing congestion, maintaining moisture, and using medications. Understanding the purpose and patterns of terminal breathing helps demystify the dying process and guide loved ones through death’s final passage with peace and closure. This natural transition marks the end of life’s journey and the beginning of rest.