Tracheostomy in amyotrophic lateral sclerosis:

We evaluated the clinical characteristics and outcome of tracheostomy in amyotrophic lateral sclerosis (ALS) using data from the Piemonte and Valle d’Aosta Register for ALS, a prospective epidemiological register collecting all ALS incident cases in two Italian regions. Among the 1260 patients incident in the period 1995e2004, 134 (10.6%) underwent tracheostomy. Young male patients were more likely to be tracheostomised. Site of onset (bulbar vs spinal) and period of diagnosis (1995e1999 vs 2000e2004) did not influence the likelihood of being tracheostomised. The mean duration of hospital stay was 52.0 days (SD 60.5). Overall, 27 patients died while still in hospital (20.1%). Sixty-five patients (48.5%) were discharged to home, whereas 42 (31.3%) were admitted to long-term care facilities. The median survival time after tracheostomy was 253 days. In the Cox multivariable model, the factors independently related to a longer survival were enteral nutrition, age, marital status and ALS centre follow-up. In conclusion, in an epidemiological setting, ALS survival after tracheostomy was <1 year. Sociocultural factors influence the probability of choice to be tracheostomised, even in a highly socialised health system as Italian one. Amyotrophic lateral sclerosis (ALS) is a neurode-generative disorder characterised by a progressive weakness and atrophy of limb, trunk, bulbar and respiratory muscles. Respiratory failure can occur at different stages, and its management is based on mechanical ventilation with non-invasive ventila-tion (NIV) or tracheostomy when NIV is no longer effective.1 There are few papers assessing the clin-ical and demographic characteristics of ALS patients with tracheostomy.2e6 The aim of the present study was to evaluate the clinical characteristics and outcome of tracheos-tomy in ALS using data from a prospective epide-miological register