Table 1 Richmond Agitation-Sedation Scale (RASS)
Score | Term | Description |
|---|---|---|
+4 | Combative | Overtly combative or violent; immediate danger to staff |
+3 | Very agitated | Pulls on or removes tube(s) or catheter(s), or has aggressive behavior toward staff |
+2 | Agitated | Frequent non-purposeful movement or patient-ventilator dyssynchrony |
+1 | Restless | Anxious or apprehensive but movements not aggressive or vigorous |
0 | Alert and calm | Â |
−1 | Drowsy | Not fully alert, but has sustained (>10 seconds) awakening with eye contact to voice |
−2 | Light sedation | Briefly (<10 seconds) awakens with eye contact to voice |
−3 | Moderate sedation | Any movement (but no eye contact) to voice |
−4 | Deep sedation | No response to voice, but any movement to physical stimulation |
−5 | Unarousable | No response to voice or physical stimulation |