Anxiety, fear, and pain are common occurrences for patients with acute respiratory failure. These symptoms may influence patients' ability to tolerate mechanical ventilation because of the development of asynchronous breathing patterns. The administration of sedatives and neuromuscular blocking agents may be necessary to facilitate ventilation and enhance oxygenation. Few published protocols exist to guide clinicians in initiating and effectively monitoring patients receiving these agents. In this article, the author focuses on the identification of patients for whom these drugs may be indicated, describes protocols currently available, and offers suggestions for improving patient monitoring to avoid the development of adverse events.