Clinical Critical Care

Critical care transport and management in Earthquake catastrophes: Lessons from Japan

Nabuo Fuke — 2026-01-08

Japan's experience with large-scale earthquakes has led to the development of a highly structured and adaptable disaster response system. This review highlights key lessons in critical care transport and disaster management from historical events such as the Hanshin-Awaji Earthquake (1995), and the East Japan Triple Disaster (2011). The "Point-Line-Plane" framework categorizes disasters by their geographical scale and helps guide tailored medical strategies. Critical care and emergency physicians must navigate the challenges posed by each disaster type, including triage, evacuation logistics, and continuity of care for vulnerable populations. The importance of Disaster Medical Assistance Teams (DMATs), staging care units, air transport, and chronic care networks in disaster response is highlighted. Previous experiences also emphasize proactive planning, multidisciplinary coordination, and robust healthcare infrastructure for better outcomes.

Venous congestion in surgical patients assessed by the Venous Excess Ultrasound Grading System (VExUS): A comprehensive review

Chanarat Suwanwichai — 2026-01-12

Venous congestion from fluid overload is an underrecognized contributor to postoperative organ dysfunction. The Venous Excess Ultrasound Grading System (VExUS) is a non-invasive Doppler-based tool for assessing systemic venous congestion at the bedside. This review outlines the physiological basis, step-by-step protocol, and current clinical evidence for VExUS use in surgical patients. While it shows potential for guiding fluid management, results across studies are mixed, and several clinical limitations affect interpretation. VExUS is feasible and promising, but further multicenter research is needed to establish its clinical value and integration into perioperative care.

Thrombocytopenia-associated multi-organ failure after Fontan operation successfully treated with plasma exchange: A case report

Thita Pacharapakornpong — 2026-01-28

Introduction: Thrombocytopenia-associated multi-organ failure (TAMOF) is a rare but life-threatening subtype of multiple organ dysfunction syndrome caused by thrombotic microangiopathy and decreased A Disintegrin and Metalloproteinase with a Thrombospondin type 1 motif, member 13 (ADAMTS-13) activity. Although commonly associated with sepsis, TAMOF is rarely reported after cardiac surgery.

Case Presentation: We report a 10-year-old girl with right atrial isomerism and complex congenital heart disease who developed TAMOF following extracardiac Fontan surgery. She presented with distributive shock, persistent thrombocytopenia, acute kidney injury requiring continuous renal replacement therapy, transaminitis, and encephalopathy. Laboratory findings demonstrated thrombotic microangiopathy with elevated inflammatory markers. Plasma exchange (PLEX) was initiated based on clinical suspicion and later confirmed by reduced ADAMTS-13 activity. After two PLEX sessions, the patient showed rapid improvement, including platelet recovery, resolution of neurological, hepatic, and renal dysfunction, and successful extubation.

Conclusions: Early recognition of TAMOF in post-cardiac surgery patients with unexplained thrombocytopenia and multi-organ dysfunction is critical. Prompt PLEX may result in clinical recovery and improved survival.