May 2010

Induced hypothermia (IH) has been used for over 60 years (1) as an adjuvant therapy in a group of critically ill patients. Described by Fay in the 1940s, (2) IH has been used in operating rooms since the early 1950s for patients undergoing cardiac surgery and neurosurgery. The use of IH after cardiac arrest was first reported in 1957 by Benson et al. (3) The beneficial effects of hypothermia in animal tests during periods of ischemia result in a wide range of biological effects and it is not a simple mechanism of action. When IH is used in any clinical

Diaphragmatic rupture occurs in 0.8-5% of patients with major blunt thoraco-abdominal trauma and up to 70% of diaphragmatic tears are missed initially. Elevation of a single hemi diaphragm can be attributed to adjacent pleural, pulmonary or subphrenic disease, or it can occur secondary to a phrenic nerve palsy. (1) Rarely, it is related to an intrinsic weakness of the diaphragm or eventration. Because diaphragmatic rupture is often associated with thoracic or abdominal injuries that require surgical treatment, the diagnosis is usually made intraoperatively in many cases.

In the Intensive Care Unit (ICU), patients are vulnerable to develop psychomotor disturbances with increase in both motor and psychological activities, often accompanied by loss of action control and disorganization of thought. Various terms have been used including agitation, anxiety and delirium. (1) Predisposing factors such as alcohol and substance abuse, male gender, advancing age, dementia and sensory impairment can further aggravate the symptoms.