During the implementation phase, daily multidisciplinary rounds will include identification of the patient's trajectory of illness and daily prescription of (a) sedation goal and (b) sedation parameters. Nurses will titrate the comfort medications as prescribed and perform a daily "wake up" test in patients during their stable phase who are not awake. During the implementation phase, a member of the research team will round separately on each patient to monitor for study compliance and offer staff support and re-training as necessary. This level of vigilance is necessary to identify aspects of the algorithm that are challenging to clinicians, and accurate reporting of protocol deviations requires an evaluation of the context of decision-making. This daily check will not continue in the early intervention arm when sustainability is evaluated. During the implementation phase, all sedation orders will be derived from standardized physician orders. This order template will serve two purposes: physician education and enhanced compliance with the algorithm