Patients will be assessed hourly, using the MMAAS, for the first four hours of admission to the study and then every 2 hours for the subsequent 8 hours. After this initial time period patients will be assessed every 4 hours until completion of the study. Each assessment will consist of recording the sedation score, temperature, heart rate, respiratory rate, ventilator set rate, blood pressure, oxygen saturation, infusion rate of Fentanyl and/or Midazolam and the need for any intervention and what that intervention included. Patients with signs of increased pain/discomfort will be assessed using the sedation scale as needed between scheduled assessments. Interventions will be made per protocol as needed between scheduled assessments. Once pt MMAAS score between +1 and –1 the patient will resume scheduled MMAAS evaluations according to protocol.