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    Richmond Agitation-Sedation Scale (RASS)

    Ranks agitation and possibility for sedation.
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    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

    Management

    • Patients with a RASS of -3 or less should have their sedation decreased or modified in order to achieve a RASS of -2 to 0.
    • Patients with a RASS of 2 to 4 are not sedated enough and should be assessed for pain, anxiety, or delirium. The underlying etiology of the agitation should be investigated and appropriately treated to achieve a RASS of -2 to 0.

    Critical Actions

    • A RASS score should be obtained on all hospitalized patients and at regular interval in all mechanically ventilated patients.
    • Unless a patient meets indication for deep sedation, a protocol for minimal sedation (RASS -2 to 0) should be used.
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    About the Creator
    Dr. Curtis Sessler
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