hospice guidelines for determining prognosis, amyotrophic lateral sclerosis (ALS)

Introduction

Guidelines:

• rapid progression of ALS
  • progression from independent ambulation to wheel-chair bound or bed-bound
  • progressing from normal to barely intelligible or unintelligible speech
  • progressive from normal to pureed diet
  • progression from independence to needing assistance with basic activities of daily living (bADL)
• critically impaired pulmonary function in patients who decline intubation or tracheostomy & mechanical ventilation
  • vital capacity < 30% of predicted
  • significant dyspnea at rest
  • supplemental oxygen needed at rest
  • patients on assisted ventilation may survive for periods considerably longer than 6 months
• nutritional compromise
  • swallowing difficulty occurs early in the illness, so that gastrostomy feeding is reasonable
  • for patients who decline artificial feeding
    • continued weight loss
    • dehydration or hypovolemia
• life-threatening complications
  • recurrent aspiration pneumonia
  • pressure ulcers, stage 3 & 4, especially if infected
  • sepsis
  • fever recurrent after antibiotics

More general terms

• hospice guidelines for determining prognosis