Is invasive ventilation initiated only in emergencies?

Invasive ventilation requires surgery to create an opening in the trachea (tracheostomy) and to enable ventilatory therapy through this connection between the trachea and the outside environment. This tracheostomy procedure can be performed on a scheduled basis, provided that the need for invasive ventilation is foreseeable and has been agreed upon.

This planned approach is preferable to invasive ventilation initiated on an emergency basis. Through advance care planning, the goal should be to avoid an emergency situation and to ensure that the tracheotomy is performed as planned. In an acute or emergency situation, intubation by an emergency physician at home or in an emergency department is necessary. Intubation involves inserting a breathing tube through the mouth while the patient is under anesthesia. Only in a second step is the surgical procedure to create a tracheostomy performed in an operating room. Intubation in an emergency situation carries higher risks than a planned procedure.

When a tracheostomy is planned, an appointment is scheduled for hospital treatment, and the timeline for anesthesia, the surgical procedure, and subsequent care in an intensive care unit is planned. This planning benefits the patient and their social circle, and also helps minimize the risks associated with the medical procedure. The fundamental decision to initiate invasive ventilation, as well as determining the appropriate timing, requires specialized expertise from physicians familiar with invasive ventilation in ALS. Furthermore, a doctor-patient dialogue is necessary to discuss the possibilities and limitations of invasive ventilation. On this basis, a competent decision regarding invasive ventilation can be made.