THE RESPIRATORY OUTCOME OF ALS
The hallmark signs of early respiratory muscle weakness are the inability to fully inhale and exhale, a weak cough, and a reduced voice volume.
ALS ultimately results in respiratory failure due to the progression of respiratory muscle weakness. Respiratory failure can be prevented and treated with use of noninvasive or invasive breathing support. People with ALS have life choices and need to indicate their wishes in their Advance Directives.
*** Education on life choices is necessary
for making informed choices and fulfilling
patient wishes. ***
Noninvasive (nasal/oral) ventilation (NIV): positive pressure air is delivered from a ventilator (small, portable machine) through the nose and/or mouth and into the lungs to support breathing. NIV can be tolerated unless oral secretions become severe.
- Tracheostomy invasive ventilation (TIV): positive pressure air is delivered from a ventilator (small, portable machine) through a tracheostomy (surgical opening in the neck) and into the lungs to support breathing. TIV supports breathing beyond respiratory failure, despite severe oral secretions. Use of TIV can be long term. Progressive disability does not cause death. ALS patients have the right to stop TIV, if desired.
- Comfort (hospice) care: indicated if NIV is no longer tolerated due to severe oral secretions and tracheostomy invasive ventilation is not desired.
MECHANICS OF RESPIRATION
What is ALS?