Study Design: The S.A.T.I.R.E. trial will be a two year, randomized control trial performed on intubated patients in the ICU (surgical and neurovascular patients). The control group will consist of intubated patients that will be sedated and given pain control with using current practice: continuous infusions of a narcotic and sedative. The trial group will consist of intubated patients that will be sedated and given pain control with an investigational timing of dosing: Q1 hour bolus dosing given in a sliding scale fashion. The target levels of sedation and pain control will not differ between the two arms of the study. Upon admission to the ICU the surgical resident on call (hereafter referred to as ICU resident) is required to assess a patient. During that time, if the patient is intubated and does not fall into exclusion criteria, the ICU resident will then assign the patient to the control arm of the study or the trial arm of the study randomly as described below. The ICU residents will use designated order sets with specific protocols for each arm of the study which are described in more detail below. Each day during the week the clinical pharmacist on staff will record patient demographics (age, gender, race, indication for mechanical ventilation, serum creatinine, APACHE II, injury severity score if trauma) and MRN#, as well as time of intubation and time of extubation if applicable. During the weekend the ICU resident will record new patients enrolled into the study (MRN only); on Monday, the investigators or clinical pharmacist will review the weekend data and retrospectively record demographics, time of intubation, and time of extubation from patients admitted to the ICU over the weekend. This Monday data collection will be assigned on a rotating weekly schedule to the investigators. Data will be collected for approximately two years; aggregate data will be analyzed every six months.