DENVER (The New York Times News Service) -- Nurse Jan Smith leaned in to adjust electrodes wired to Thomas McCarty's scalp.

McCarty suddenly whirled in his bed, his arms rising as if trying to defend himself from attack. His eyes are wide.

"It's OK honey," says McCarty's wife, Kim, grabbing his forearm. "It's just a nurse. She's helping you."

For two years, the 38-year-old master carpenter has suffered unexplained seizures like the ones that recently landed him at Denver Health Medical Center. Each hospital stay is characterized by the same confusion, fear and disorientation.

At Denver Health's 24-bed medical intensive care unit, "hospital-associated delirium" is so prevalent it afflicts eight out of 10 patients. Dr. Ivor Douglas, director of Denver Health's MICU, says one of the "most potent predictors" of a patient's inability to recover swiftly from their stay in intensive care is delirium.

"This is an enormous public health problem," Douglas said.

"It is something that if we could prevent or avoid ... as a nation we could save billions and billions in critical care costs."

While recognizing and preparing for debilitating confusion is on the rise, solutions remain elusive.

For one, finding the reason for post-operative or hospital-associated delirium has been tricky. Researchers say the source likely is a mix of medications aggravated by broken sleep patterns, the trauma of surgery or treatment, and the helpless, immobilized life of a patient in a hospital's critical care unit.

Treatment for delirium, until recently, commonly involved a higher dose of sedatives.

"A number of years ago the confusion was seen as a nuisance, but really didn't have a lot of significance," said Dr. Edward Marcantonio, professor of medicine at Harvard Medical School and a 17-year researcher of delirium.

"If a person was too disruptive, the treatment was to sedate the patient. Now, with increasing awareness that this is an important problem ... doctors and nurses work to identify the underlying factors that might be causing it," Marcantonio said.

"The more new medications you add, the greater the risk you have of causing more problems."

Last year, Dr. Kelly Greene, intensive care director at Littleton Adventist Hospital, began studying delirium in her patients. She found that patients on a ventilator -- who are typically sedated -- suffered an 80 percent rate of delirium.

Non-ventilated patients suffered delirium at a rate of 25 percent to 30 percent. Those patients with symptoms of delirium typically stayed in intensive care twice as long as more cognizant patients. They also suffered after their hospital stay with something not unlike post-traumatic stress disorder, Greene said.

"It's a pretty traumatic experience for many folks who go through the ICU," Greene said.

And the mental trauma can be easy to miss. Sometimes, Greene said, her patients seem perfectly content, even dozing through heavy sedation and pain management. Inside their head is a different case.

"At first glance they'd be sitting in the ICU, fine, with no issues. They'd come back and tell us two days later 'I thought I was being kidnapped.' Or 'I saw spiders on the wall.' Or 'I thought I was on a cruise ship,' " Greene said.

Since the Littleton Adventist study ended three months ago, Greene is leading a systemwide change that includes a delirium assessment as part of routine care for intensive care patients in Centura Health, Colorado's largest network of hospitals.

The changes include nonmedical interventions like inviting family members to stay in the room, flooding rooms with light during the day and keeping things dark and mellow at night. Nurses encourage family to bring familiar items into the room, like a blanket or a picture. Calendars and clocks hang on the walls.

Nurses and doctors continually reorient the patient every time they come in, telling patients where they are and what's happening.

The new delirium protocol also includes re-evaluating the need for heavy sedation. Sometimes it's best to avoid sedation and keep the patient alert and awake, a significant shift from traditional critical care strategies.

"I think we have really changed how we look at sedating patients in the ICU," Greene said. "The old concept was that if they are sleeping that is good. But now we are finding out that sleeping with some of these medications is not always good for the patient."

At Denver Health, Douglas, who has worked in critical care since 1991, walks by all 24 rooms in his critical-care unit. Large, open rooms are awash in daylight. Once the sun sets, the lights are dimmed and soothing classical music will trickle quietly into each room, helping ease the transition to sleep. Nurses assess their patients' mental state as part of hourly checks.

The inarticulate rambling of a diabetic patient prompted Douglas to scan her brain for signs of a stroke.

Kidney failure, blocked bladder, alcohol withdrawal, lung failure or other problems can all be compounded with varying degrees of delirium.

Sometimes nurses sit with patients just to quell incoherent and irrational behavior.

The delirium protocol has been a part of Denver Health's critical care for four years. The system has allowed the hospital's staff to directly treat the delirium, either through simple environmental changes or adjustments to medications, Douglas said.

"Instead of saying, 'Oh this patient is just crazy,' we are able to make changes and instead of making things worse, we can stop and try something else," Douglas said.

Still, on a recent day, 18 of 22 patients were suffering from delirium, so the work to understand the condition continues.

Douglas is guiding clinical studies at Denver Health that are testing medicines and strategies that can alleviate delirium. The hospital is in line for a national grant that would have it working with several other hospitals in the largest study yet of delirium in critical-care patients.

"There is more funded research in the area than ever before," Harvard's Marcantonio said.

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