When nightmares happen after the intensive care unit When Lygia Dunsworth was sedated, intubated and strapped down in the intensive care unit at a Fort Worth, Texas, hospital, she was racked by paranoid hallucinations: Outside her window, she saw helicopters evacuating patients from an impending tornado, leaving her behind. Nurses plotted to toss her into rough lake waters. Ms. Dunsworth, who had been gravely ill from abdominal infections and surgeries, eventually recovered physically. But for several years, her stay in intensive care tormented her. She wouldn't even talk about it. "Either people think you're crazy or you scare them," said Ms. Dunsworth, 54, a registered nurse. In fact, she was having symptoms associated with post-traumatic stress disorder. Annually, about 5 million patients stay in an intensive care unit in the United States. Studies show that up to 35 per cent may have symptoms of PTSD for as long as two years after that experience, particularly if they had a prolonged stay due to a critical illness with severe infection or respiratory failure. Those persistent symptoms include intrusive thoughts, avoidant behaviours, mood swings, emotional numbness and reckless behaviour. Yet ICU-induced PTSD has been largely unidentified and untreated. When patients leave the ICU, said Dr. O. Joseph Bienvenu, a psychiatrist and associate professor at Johns Hopkins University School of Medicine, "Everyone pays attention to whether patients can walk and how weak they are. But it's the exception for them to be screened for psychiatric symptoms like post-traumatic stress or low mood. Now critical care specialists are trying to prevent or shorten the duration of the mood disorders, which can rattle not only ICU patients but their frantic relatives. Researchers have begun to identify the ICU treatment that has led to the most harrowing flashbacks: sedation. In January, the Society of Critical Care Medicine, concerned about the weakened physical, cognitive and psychological condition of many post-ICU patients, released new sedation guidelines. They urged ICU doctors to treat pain first and only then to weigh using benzodiazepines for anxiety. Dr. Dale M. Needham, an associate professor in pulmonary and critical care medicine at Johns Hopkins, noted that even when the sedation has stopped, a patient's delirium may continue. Many patients return home mentally shaken, with physical and cognitive weaknesses. Dr. Needham said they haven't "fully recovered within six months or a year." Therefore, he added, the ICU stay can place a lingering burden on both the patient and the family. New York Times