Critical and intensive care management

Dr Mothilal can assist in emergency respiratory care in cases where breathing is compromised. Through non-invasive, invasive and advanced ventilation strategies, extracorporeal membrane oxygenation (ECMO), chest drainage, and indwelling pleural catheters, he is a specialist pulmonologist with experience in emergency ventilation in acute respiratory failure.

What critical and emergency services does he provide?

Non-invasive ventilation (NIV) refers to providing ventilatory support through the patient's upper airway using a mask. Non-invasive ventilation (NIV) may be used in cases of acute exacerbations (such as asthma or COPD) or for mild to moderate or hypervolemic pulmonary oedemas. On the other hand, invasive and advanced ventilation strategies are done using a tracheal tube, laryngeal mask, or tracheostomy, bypassing the upper respiratory tract. More invasive ventilation is chosen in clinical cases in which airways, breathing, circulation and disability are at risk. It may be done for airway protection, apnoea hyperventilation, respiratory distress, severe circulatory shock, controlled hyperventilation or in cases of poor blood gases or failed pulmonary function tests.

There is a range of conditions affecting the lung mechanics and gas exchange, lung compliance, airflow and restriction of the chest wall, for which emergency ventilation may be needed. Those in need of intubation, non-invasive, invasive and advanced ventilation include:

  • Acute respiratory distress syndrome
  • Pneumonia
  • Asthma
  • Chronic obstructive pulmonary disease
  • Cardiogenic pulmonary oedema
  • Congestive heart failure.
  • Apnoea with respiratory arrest
  • Spinal cord injuries
  • Stroke
  • Trauma
  • Shock
  • Guillain-Barre syndrome
  • Drug overdoses & side-effects.

In cases where ventilation may not be sufficient or sustainable due to the high-pressure rate of oxygen these machines supply, ECMO services may be better suited.

  • Extracorporeal membrane oxygenation (ECMO)

    Extracorporeal membrane oxygenation (ECMO) is provided for temporary support in heart and/or lung failure cases. ECMO works by supplementing the responsibilities of the lungs and heart by adding oxygen to the blood and helping the heart pump properly so that the heart and/or lungs can recuperate. While ventilation may assist in such cases, extracorporeal membrane oxygenation is able to spare the effort of the lung completely, oxygenating the blood outside the body to serve oxygenated blood to the organs. ECMO is often used for infants, young children and adults (in severe cases) for pneumonia, sepsis, lung failure, heart failure, post-cardiac syndrome, temporary bridging and bridging therapy. In cases where fluid has built up in the pleural space, chest drainage through indwelling pleural catheters may be considered.

  • Chest drainage and indwelling pleural catheters

    Chest drainage, also known as pleural effusion drainage, removes the fluid from the space between your lungs and chest cavity, the pleural space. For chest drainage, an indwelling pleural catheter is placed during a procedure known as a thoracostomy. The chest tube (or thoracoscope) is a thin plastic tube inserted into the pleural space connected to a machine to help drain air, blood, or fluid that may place pressure on the lung during a thoracostomy. This chest tube remains, and once the fluid or air is removed, your lungs should be able to expand properly. Pleural effusion drainage or chest drainage is usually indicated to maintain respiratory function, which may be compromised by the build-up of air, blood or fluid in the pleural space. This is often caused by:

    • Inflammation or infection in the pleural space (an empyema) such as tuberculosis and pneumonia
    • Excess blood builds up in the chest cavity due to an injury, tumour, or bleeding disorder.
    • The build-up of fluid in the pleural space (known as pleural effusion) due to heart failure, lymphatic fluid, a lung tumour, a collapsed lung (pneumothorax) due to chest trauma

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Christiaan Barnard Memorial Hospital

Suite 1613, 16th floor, Netcare Christiaan Barnard Memorial Hospital, Cnr DF Malan Street and Rua Bartholemeu Dias Plain, Foreshore, Cape Town, 8001