Among the key innovations of critical care medicine is treatment directed by continuously measured objective physiologic data. A prime example is the dosing of vasopressors using continuous measurements of systemic arterial pressure acquired from an indwelling arterial catheter. Similarly, the settings of mechanical ventilators are based on pressure and volume measurements of airway gases and arterial blood gas analysis. However, not all of the care provided in ICUs is so carefully monitored and titrated. This is especially true concerning sedation and analgesia, which are widely used in ICUs, as reported in this issue of CHEST (see page 496), by Arroliga and colleagues. These investigators analyzed data from a prospective, multicenter, international cohort of 5,183 adult ICU patients who received mechanical ventilation for > 12 h in 361 ICUs. Sixty-eight percent of these patients received sedation while being mechanically ventilated, while 13% also received a neuromuscular blocker for at least 1 day. The latter patients had a 50% mortality rate. The sedated patients had longer durations of mechanical ventilation, weaning time, and ICU stays than nonsedated patients. These results are not unexpected since patients receiving sedation and neuromuscular blockade tend to be the most severely ill. However, there is always the lingering question as to whether sedation, analgesia, and administration of neuromuscular blockers contribute to the morbidity and mortality of such patients or are only indications of severe illness.