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Terminal respiratory secretions, or death rattle, occur in up to 90 percent of all dying persons and is often distressing to families, caregivers, and practitioners. Unfortunately, current pharmacological approaches to reduce terminal respiratory secretions (i.e.: atropine sulfate, hyoscyamine, and scopolamine) are often ineffective and have multiple untoward side effects such as xerostomia, xeropthalmia, restlessness, hallucinations, palpitations, constipation, and urinary retention. A novel concept in terminal respiratory secretion management is aromatherapy, or the use of essential oils. Aromatherapy is often understood as aroma from essential oils eliciting psychological or physiological responses via the limbic system in the brain, but when applied topically, essential oils elicit physiological changes at and/or near the site of application. The herbal form of hyssop has been used for respiratory disorders since approximately 400 B.C. The purpose of this project was to review the literature for ascertaining the effectiveness of topically-applied Hyssopus officinalis L. essential oil in reducing terminal respiratory secretions in patients at end-of-life.
Methods:
PubMed, CINAHL, OvidMedline, and ProQuest databases were searched for peer-reviewed journal articles in English with the following keywords: human, essential oil, hyssop, death rattle, terminal respiratory secretions, end-of-life, and Hyssopus officinalis. Of the 7,437 articles pertaining to essential oils, only one article contained hyssop. Of the 143 articles pertaining to terminal respiratory secretions or death rattle, only 39 met inclusion criteria. However, no combined search resulted in both essential oils and terminal respiratory secretions.
Results:
The literature review found insufficient evidence-based knowledge on using topically-applied essential oils for reduction of terminal respiratory secretions in patients at end-of-life. No studies were found assessing any essential oil efficacy in reducing terminal respiratory secretions. Several studies of pharmacological approaches to terminal respiratory secretion management were found; however, none demonstrated efficacy.
Conclusion:
Although used in holistic nursing and aromatherapy practice, the efficacy to reduce terminal respiratory secretions using topical Hyssopus officinalis L. essential oil and its primary constituents (i.e., esters, ketones, monoterpene hydrocarbons, and monoterpene alcohols) has not been previously investigated. Hyssopus officinalis L. has demonstrated efficacy in reducing the audible rattle associated with terminal secretions in home hospice case studies. The results of this project are expected to provide a foundation for future research investigating the effectiveness of Hyssopus officinalis L. essential oil for reducing terminal respiratory secretions in patients at end-of-life.