Emergency Tracheostomy with Invasive Ventilation in Patients with Amyotrophic Lateral Sclerosis Increases Hospitalization Duration and Long-Term Complications

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Amyotrophic lateral sclerosis (ALS) progresses to respiratory failure.Tracheostomy with invasive ventilation (TIV) can prevent type 2 respiratory failure and extend survival.However, some patients with ALS require emergency intubation due to complications such as respiratory failure or aspiration pneumonia.In this study, we aimed to compare clinical features, hospitalization duration, and long-term complications between patients undergoing elective versus emergency TIV induction.This two-center retrospective cohort study included 16 patients who underwent elective TIV and 11 who underwent emergency TIV.Analyzed clinical variables included age, sex, forced vital capacity percentage (%FVC), and partial pressure of carbon dioxide at the time of TIV induction.Additionally, total hospitalization duration and the frequency of long-term complications following TIV were evaluated.Patients in the emergency TIV group were significantly older (69.3 and 53.1 years old, respectively; P = 0.023) and had a lower %FVC (30% and 51%, respectively; P = 0.0041) compared with the elective TIV cohort.Notably, 36% (n = 4) of emergency patients were intubated before being diagnosed with ALS.Hospital stay at the time of TIV was 3.6 times longer in the emergency cohort.Long-term complications and related hospital stays were 3.8 and 10 times more frequent, respectively.Respiratory complications, such as pneumonia, were the most common.These findings indicate that elective TIV induction in patients with ALS may lead to shorter hospitalization and fewer long-term complications.Early respiratory planning may improve patient outcomes and reduce healthcare burden.

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