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    Attention COACH STUDY participants:

    The principal investigators of the study request that you use the official version of the modified score here.

    Richmond Agitation-Sedation Scale (RASS)

    Ranks agitation and possibility for sedation.

    INSTRUCTIONS

    See Evidence for definitions of criteria.
    When to Use
    Pearls/Pitfalls
    Why Use

    The RASS can be used in all hospitalized patients to describe their level of alertness or agitation. It is however mostly used in mechanically ventilated patients in order to avoid over and under-sedation.

    • The Richmond Agitation and Sedation Scale (RASS) is a validated and reliable method to assess patients’ level of sedation in the intensive care unit.
    • As opposed to the Glasgow Coma Scale (GCS), the RASS is not limited to patients with intracranial processes.
    • RASS is mostly used in the setting of mechanically ventilated patients in the intensive care unit to avoid over- and under-sedation.
    • A RASS of -2 to 0 has been advocated in this patient population in order to minimize sedation. This strategy has been shown to reduce mortality, and to decrease the duration of mechanical ventilation and the length of stay in the ICU.
    • The RASS is different than the levels of sedation/analgesia used by the American Society of Anesthesia (minimal, moderate, deep, general), and the two should not be used interchangeably.
    • Mechanically ventilated that are deeply sedated (RASS of -3 or less) have been shown to remain intubated and mechanically ventilated for longer periods of time. This in turn leads to longer ICU stays and higher mortality.
    • Similarly, mechanically ventilated patients that are too agitated are at risk of self-extubation and of ventilator dyssynchrony.
    Combative
    +4
    Very agitated
    +3
    Agitated
    +2
    Restless
    +1
    Alert and calm
    0
    Drowsy
    -1
    Light sedation
    -2
    Moderate sedation
    -3
    Deep sedation
    -4
    Unarousable sedation
    -5

    Result:

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    Next Steps
    Evidence
    Creator Insights
    Dr. Curtis Sessler

    About the Creator

    Curtis Sessler, MD, is a professor at Virginia Commonwealth University (VCU) Health System. He is also director of the Center for Adult Critical Care and medical director of Critical Care and the Medical Respiratory ICU at the Medical College of Virginia (MCV). Dr Sessler’s research interests focus on ICU sedation, prevention of nosocomial infection, mechanical ventilation, and procedural competency.

    To view Dr. Curtis Sessler's publications, visit PubMed

    Are you Dr. Curtis Sessler? Send us a message to review your photo and bio, and find out how to submit Creator Insights!
    MDCalc loves calculator creators – researchers who, through intelligent and often complex methods, discover tools that describe scientific facts that can then be applied in practice. These are real scientific discoveries about the nature of the human body, which can be invaluable to physicians taking care of patients.
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