Other tailored sedation practices formulated by the multidisciplinary group have shown improvement in ventilator outcomes and length of stay. de Wit et al3 showed that an intermittent bolus sedation practice using the Richmond Agitation Sedation Scale achieved improved outcomes compared with a strategy of continuous sedation and daily interruption. Historically, this ICU has a large proportion of patients with substance abuse issues. This highlights the usefulness of a local protocol meeting the needs of the patient population served. Similarly, Robinson et al4 used a tailored approach in the management of trauma patients. The investigators’ goal was to avoid daily interruption of analgesia given the nature of the injuries and the associated continuous pain. The local group developed a tiered approach to care, the analgesia-delirium-sedation protocol. Continuous analgesic therapy was provided with opiate agents. Next, anxiety was addressed initially with nonpharmacologic intervention before haloperidol and then sedative agents were needed. Propofol was the continuous sedative agent, but if sedation was needed for >48 h, intermittent midazolam was then the preferred agent. Implementation of this analgesia-delirium-sedation approach led to improvements in outcomes. The protocol used not only the Richmond Agitation Sedation Scale but also the delirium scale, Confusion Assessment Method for the ICU. Although the patient populations served by de Wit et al3 and Robinson et al4 may have been specialized, it should be noted that the Strøm et al’s5 no-sedation protocol enrolled a general population with a significant level of illness as measured by severity of illness scores (APACHE [Acute Physiology and Chronic Health Evaluation] II and SAPS [Simplified Acute Physiology Score]).