Critical care has entered an era in which a “less is more” therapeutic approach, such as use of low tidal ventilation in ARDS or conservative transfusion practice, is linked to better patient outcomes. Furthermore, preservation of mental and physical activity that mimics a healthy state by avoiding deep sedation and applying early mobilization is now widely embraced. Accordingly, a strategy of routinely applying pharmacologically induced deep sedation and paralysis that violates these basic tenets should be scrutinized before it is embraced. Dr Hall presented arguments in favor of the routine use of paralytic agents in severe ARDS.1 Admittedly, the pivotal placebo-controlled randomized controlled trial (RCT) in severe ARDS by Papazian et al2 yielded impressive findings. Randomization to cisatracurium was associated with more rapid recovery from respiratory failure, absence of attributable neuromuscular disease, and trends for better survival. As in all aspects of patient care, potentially risky management should be limited to patients for whom benefit is most likely.