The study design is a randomized controlled trial with delayed intervention in the control hospital. Because the intervention is an educational and organizational change directed at all PICU clinicians, the unit of randomization and analysis is the PICU. During the start-up phase, case report forms will be developed and a consensus meeting with all nurse and physician co-investigators will be conducted. The purpose of this consensus meeting will be to review the Children's Hospital Boston experience with the sedation algorithm and reach agreement on its application in the two PICUs. System nuances may impact protocol implementation and will require group discussion and multidisciplinary problem solving.