The Richmond Agitation and Sedation Scale: The RASS*

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Score	Description
+4	Combative - Overtly combative, violent, immediate danger to staff
+3	Very agitated - Pulls or removes tube(s) or catheter(s); aggressive
+2	Agitated - Frequent non-purposeful movement, fights ventilator
+1	Restless - Anxious but movements not aggressive vigorous
0	Alert and calm
-1	Drowsy - Not fully alert, but has sustained awakening (eye-opening/eye contact) to voice (>10 seconds)
-2	Light sedation - Briefly awakens with eye contact to voice (<10 seconds)
-3	Moderate sedation - Movement or eye opening to voice (but no eye contact)
-4	Deep sedation No response to voice, but movement or eye opening to physical stimulation
-5	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