Tracheostomy-associated ventilation for the respiratory insufficiency caused by amyotrophic lateral sclerosis (motor neurone disease (MND)) is a complex issue with practical, ethical and economic dimensions. This article considers the current prevalence of tracheostomy in MND, the evidence for its benefit both for survival and quality of life, and the practicalities of its implementation. The decision to request invasive ventilatory support is among the most challenging for those living with MND. Neurologists should be prepared to discuss this option openly and objectively: we suggest a framework for discussion, including withdrawal of therapy.
- amyotrophic lateral sclerosis
- motor neurone disease
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Contributors MRT conceived the review, drafted the introduction, discussion framework, conclusions, and synthesised the overall draft manuscript; CF drafted the section on withdrawal; CJMD drafted the section on benefit; AHN drafted the section on prevalence; JP drafted the section on logistics; KT drafted the section on cause of death; All authors edited the synthesised manuscript.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Commissioned. Externally peer reviewed by Robin Howard, London, UK, and Nigel Leigh, London, UK.