The Richmond Agitation and Sedation Scale: The RASS*

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Combative - Overtly combative, violent, immediate danger to staff


Very agitated - Pulls or removes tube(s) or catheter(s); aggressive


Agitated - Frequent non-purposeful movement, fights ventilator


Restless - Anxious but movements not aggressive vigorous


Alert and calm


Drowsy - Not fully alert, but has sustained awakening (eye-opening/eye contact) to voice (>10 seconds)


Light sedation - Briefly awakens with eye contact to voice (<10 seconds)


Moderate sedation - Movement or eye opening to voice (but no eye contact)


Deep sedation

No response to voice, but movement or eye opening to physical stimulation


Unarousable - No response to voice or physical stimulation

Procedure for RASS Assessment

  1. Observe patient
    • Patient is alert, restless, or agitated. (score 0 to +4)
  2. If not alert, state patient’s name and say to open eyes and look at speaker.
    • Patient awakens with sustained eye opening and eye contact. (score –1)
    • Patient awakens with eye opening and eye contact, but not sustained. (score –2)
    • Patient has any movement in response to voice but no eye contact. (score –3)
  3. When no response to verbal stimulation, physically stimulate patient by shaking shoulder and/or rubbing sternum.
    • Patient has any movement to physical stimulation. (score –4)
    • Patient has no response to any stimulation. (score –5)

If RASS is -4 or -5, then Stop and Reassess patient at later time

If RASS is above - 4 (-3 through +4) then Proceed to Step 2


*Sessler, et al. AJRCCM 2002; 166:1338-1344.

Ely, et al. JAMA 2003; 289:2983-2991

Special Thanks


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  1. Title: The Richmond Agitation and Sedation Scale: The RASS*
  2. Author:  Michigan Medicine
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The Richmond Agitation and Sedation Scale: The RASS*,  Michigan Medicine, Dept of Surgery,  “CC BY-NC 4.0”

Last reviewed: 09 June 2021