Non-Sedated Cannula Replacement in Home-Care Patients With Amyotrophic Lateral Sclerosis: Cost Reduction and Patient-Family Satisfaction Evaluation

This study describes a home-based tracheostomy tube replacement protocol for individuals diagnosed with amyotrophic lateral sclerosis (ALS) requiring invasive mechanical ventilation. Implemented between May 2020 and July 2024, the protocol was offered to 16 eligible patients, with 14 opting for home-based care under the supervision of the Carlos III/La Paz Hospital. Procedures were conducted without sedation by a multidisciplinary team, with the aim of maintaining patient safety and continuity of care. A total of 120 home-based replacements were performed, most without major complications or the need for emergency hospitalization. In comparison to hospital-based procedures, the home protocol was associated with an estimated cost reduction of approximately €340 per case, potentially resulting in annual savings of €10,200. Patients reported high satisfaction, noting decreased caregiver burden and improved perceived quality of care. While limited by patient selection criteria, these preliminary findings suggest that home-based tracheostomy care may be a feasible, safe, and cost-effective alternative for long-term management in ALS.