Loud breathing but not agonal respiration

[val_f]

PT is a young female with leptomeningeal mets from gastric primary, under home hospice care. Vitals are stable, though tachycardia has persisted for weeks. When assessed for discomfort she sometimes responds by shaking her head when the answer is negative. Eyes are usually in a barely open state. About 6-7 on GCS. She has been on PCA Dilaudid with 3mg/hr basal and 4mg bolus, and has Scop patches, Ativan and Haldol as needed. Most of the time she seems comfortable. Her SpO2 is 92-98, but reading from right hand is consistently about 5 pts lower than the left, so doctor says circulation problem may preclude accurate reading.

What her family finds most distressing is when exhaling she produces this loud sigh/moan that can be heard across the room. It doesn't sound like agonal breating. There's no gasping or gurgling but rather more similar to sighing loudly after exertion. It's very consistent, sometimes loud as a cry, rarely almost inaudible. Does not seem to be affected by position, oxygen, or the administration of any meds, like Ativan or a Dilaudid bolus.

Doctor says it might be reflexive or neurological due to the brain mets. Has anyone seen this before or has cared for patient with brain mets that might exhibit unique symptoms?

Wanted to add that when exhaling her whole head moves slightly due to the force of the air coming up her throat.

[tyvin, BSN, RN]

Why are you giving her haldol?

Anyway; it sounds to me that she is comforting herself. We all can do a heavy moan to relieve stress. She's passing on...she knows this.

People tend to try to understand every move a passing person is making and sometimes they are just comforting themselves and or there is no explanation. The whole object of passing at home with family is to be with them not to put the patient under a microscope.

Don't over-medicate her to silence her because it upsets the family. Does she look ok when moaning? Does she appear in distress, is it a regular moan and a painful moan? Is she congested, have you checked to make sure no pressure ulcers, impaction, etc.. If not, just let her deal with her death her way.

Perhaps this is the only way she can express energy as many do have a spurts of energy before passing. I've had couple diaphragm moaners. But as always, hard to say without actually seeing her. Bless her...