Administration of the optimal dose of any medication requires knowledge of the desired and potentially unwanted drug effects, keen observation, and a process of repeated assessment and titration of dosage. Recognition that this is a dynamic process is important, since sedative needs differ from patient to patient, and may vary markedly over time for any given patient. To be considered effective, the drug(s) and dosage should meet the primary goal(s) for the individual patient, such as to control pain, to facilitate patient tolerance of mechanical ventilation, or to control agitated behavior. While it may be clear when the goal is not met (ie, the patient reports pain or is overtly agitated), clinicians have often relied on indirect, and nonspecific, signs of “distress” such as facial grimacing, or unexplained tachycardia, tachypnea, hypertension, diaphoresis, or tearing.6,14 However, the patient who is no longer experiencing distress may, in fact, be receiving an excessive dose, with progressive accumulation of drug and/or active metabolites resulting in delayed recovery. A structured approach to sedation management that emphasizes close monitoring and goal-directed titration of medications can improve this process.6–7 In many hospitals, this quest is pursued by a multidisciplinary team that includes physicians, nurses, and pharmacists working in concert.7 A key component of this approach is the use of a sedation scale, a tool that can enhance accurate and consistent medication titration by clinicians, improve understanding and communication,6–7,15and reduce the incidence of excessive drug-induced stupor.16 In this issue of CHEST (see page 1883), Dr. Weinert and Ms. McFarland report the development and validation of such a scale, the Minnesota Sedation Assessment Tool (MSAT).