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Background <p>Respiratory complications represent a&#xa0;leading cause of hospital admission and mortality in amyotrophic lateral sclerosis (ALS). In the prehospital setting, ALS frequently presents as acute ventilatory decompensation characterized by dyspnea, secretion retention, failure of noninvasive ventilation (NIV), or tracheostomy-related complications. Such encounters often constitute an interface between emergency and palliative care.</p> Objective <p>Practice-oriented approach for a&#xa0;structured, palliative care-oriented and at the same time emergency medicine-pragmatic approach to preclinical care of patients with ALS and respiratory decompensation.</p> Methods <p>Narrative review based on current literature and established clinical decision-making and communication principles, with a&#xa0;focus on practical prehospital management strategies.</p> Results <p>Key prehospital priorities include stabilization of ventilation and airway clearance, early clarification of treatment goals including emergency plans or advance care planning, and appropriate care navigation to specialized centers. Secretion retention and aspiration are common triggers of respiratory crises and require active management. A&#xa0;NIV-based strategy combined with systematic troubleshooting may prevent invasive escalation. The indication for endotracheal intubation requires careful consideration, as it frequently results in long-term invasive ventilation.</p> Conclusion <p>A&#xa0;structured, ventilation-focused prehospital approach integrating airway management and early goals-of-care clarification improves symptom control, reduces unintended escalation, and supports goal-concordant care in patients with ALS.</p>

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Präklinische Versorgung respiratorischer Dekompensation bei amyotropher Lateralsklerose

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月13日

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  • Tim Schröder,
  • Timur Sellmann

摘要

Background

Respiratory complications represent a leading cause of hospital admission and mortality in amyotrophic lateral sclerosis (ALS). In the prehospital setting, ALS frequently presents as acute ventilatory decompensation characterized by dyspnea, secretion retention, failure of noninvasive ventilation (NIV), or tracheostomy-related complications. Such encounters often constitute an interface between emergency and palliative care.

Objective

Practice-oriented approach for a structured, palliative care-oriented and at the same time emergency medicine-pragmatic approach to preclinical care of patients with ALS and respiratory decompensation.

Methods

Narrative review based on current literature and established clinical decision-making and communication principles, with a focus on practical prehospital management strategies.

Results

Key prehospital priorities include stabilization of ventilation and airway clearance, early clarification of treatment goals including emergency plans or advance care planning, and appropriate care navigation to specialized centers. Secretion retention and aspiration are common triggers of respiratory crises and require active management. A NIV-based strategy combined with systematic troubleshooting may prevent invasive escalation. The indication for endotracheal intubation requires careful consideration, as it frequently results in long-term invasive ventilation.

Conclusion

A structured, ventilation-focused prehospital approach integrating airway management and early goals-of-care clarification improves symptom control, reduces unintended escalation, and supports goal-concordant care in patients with ALS.