What do you use routinely for sedation on patiently requiring mechanical ventilation? Our first line routine is fentanyl @ 1mcg/kg/hr and midazolam at 1mcg/kg/min and we increase as patient needs to illicit acceptable sedation. The unit I work in has a large population of transplant patients that get sick and are readmitted, required ventilation, but have a great tolerance to drugs. Our institution allows for Precedex infusions of no longer than 24 hours (bummer!). I've seen them switch to a ketamine gtt( and the kids freak if there's no benzo on board as well), pentobarbital gtt (love!), and all the PRNS under the sun: lorazepam, chloral hydrate. We use paralyzingly agents only if indicated, but as we know this isn't a sedative. Any input greatly appreciated!