Although I hate to “rain on the parade” of Khorfan and colleagues,1 it is possible, if not likely, that methodologic nuances of aerosol delivery undermine the validity of their conclusions in their article in CHEST (December 2011), which states that “nebulized albuterol does not cause significant tachycardia or tachyarrhythmias.”1 In delivery of therapeutic aerosols, the devil is in the details, and the “Materials and Methods” section in the article does not provide any information regarding the aerosol delivery techniques used for study patients.1 This is especially true in patients who are mechanically ventilated, who composed >50% of the sample, in which we proved that veritably none of 100 puffs of albuterol was delivered to patients’ airways.2 Multiple variables, including circuit design, humidification, flow rates, and tidal volumes, impact aerosol delivery to critically ill patients.3 Poor techniques can lead to the illusion of treatment (ie, doses administered but not delivered to the airways because they rain out in the circuit). Accordingly, this study should be interpreted cautiously, because no evidence (eg, of reduced airway resistance) is provided to support that any of the administered doses were delivered.