[Ambulatory intensive therapy in the bulbar form of amyotrophic lateral sclerosis].

Due to the instability of their respiratory functions, patients suffering from ALS are potentially patients for permanent intensive care. The desire to provide care in the familiar environment at home on the one hand, and qualified professional support on the other hand, gives rise to the concept of ambulatory intensive care. This concept might be successfully implemented if one proceeds according to the motto: it is not the patient who is committed to technical facilities, but rather that the technical facilities ought to be committed to the patient. Home care, gastrostomy, tracheostomy, mobile suction drainage and the feasibility of home ventilation provide the groundwork for competent palliative medical care even in the bulbar form of ALS. Home care of such patients would be enhanced in terms of both security and quality if it were possible to have regular ambulatory check of the vital functions at intensive care units. In emergency cases, once their respiratory functions are stabilized patients could be discharged into home nursing after a short-term stay at the intensive care unit. Ambulatory intensive therapy would both serve to ease the burden of intensive care units in terms of costs and personnel, and to improve the life quality of patients.