Amyotrophic lateral sclerosis: Timing, goals and effectiveness

Tan Geak Poh
Tan Tock Seng Hospital, Singapore

Amyotrophic lateral sclerosis (ALS) is a debilitating disease resulting in severe functional impairment and reduced life expectancy. ALS presents complex challenges in critical care, particularly in the context of respiratory failure and advanced disease progression. The management of ALS requires understanding of disease trajectory, patient priorities, and the role of various supportive interventions. This presentation explores contemporary approaches to ALS management in the intensive care unit, emphasizing the integration of non-invasive ventilation, ethical decision-making, and multidisciplinary coordination. Key discussion points include the optimal timing for initiating non-invasive ventilation, considerations for gastrostomy, and transitioning to tracheostomy or long-term invasive ventilation. The session will also highlight decision-making frameworks that align therapeutic interventions with patient-defined goals—balancing prolongation of life with quality of life in the context of progressive neuromuscular decline. Effectiveness will be addressed through symptom control, survival benefit, and caregiver burden, emphasizing the importance of multidisciplinary care, early advance care planning, and cultural factors influencing end-of-life decisions. Through case vignettes, participants will gain a structured approach to navigating complex clinical scenarios in ALS.