Ventilatory support and palliative care in amyotrophic lateral sclerosis (ALS)

Assisted ventilation in amyotrophic lateral sclerosis (ALS) is a hybrid treatment concept which varies during disease progression. It can prolong life, but also has the effect, possibly its main one, of relieving dyspnoea. Despite having a predictable disease course, many patients with ALS defer decision-making until a crisis and arrive in emergency. Nevertheless, decision-making in end of life is complex in these circumstances and effective communication is the only recipe that will yield success. Sometimes, it can also be included in a palliative care protocol, which should not be limited to ventilation. As in many chronic diseases with fatal outcomes, management of palliative care in ALS can only result from group reflection and multidisciplinary teamwork; the doctor and the patient are just two members of this team. This text will give tools to manage ALS patients under mechanical ventilation. (C) 2010 Elsevier Masson SAS. All rights reserved.