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Purpose Medication supply shortages can potentially compromise patient care, and shortage of an analgesic such as fentanyl prompts the need for alternative therapy. The combined use of analgesics and sedatives is commonly employed in mechanically-ventilated patients to help reduce their pain, anxiety, and recall of traumatic events. This case series presents the experiences with the substitution of morphine infusion in place of fentanyl in a sedation protocol during a period of medication shortage. Methods A case series evaluating intubated adult (>18 years old) patients admitted to the intensive care unit (ICU) requiring continuous intravenous analgesics and sedatives to facilitate MV was performed for the month of November 2011. Six patients experiencing respiratory distress due to varying etiologies were managed with morphine and midazolam to facilitate MV during a period of fentanyl shortage and were evaluated as a part of a qualitative assurance initiative. Findings Attainment of a predetermined RASS and time to achieve this goal were monitored. Furthermore, any adverse effects, including hypotension (defined as systolic blood pressure <90 mmHg) and self-extubation, were recorded. Three of the six patients required greater than 24 hours to achieve their targeted RASS. All of the patients receiving morphine experienced hypotension and required medical interventions, including the use of saline boluses and increased norepinephrine doses to sustain adequate blood pressure in those who were already hemodynamically unstable. There was one episode of self-extubation, which subsequently required re-intubation. [ABSTRACT FROM AUTHOR]