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Richmond Agitation-Sedation Scale (RASS)
RASS
Monitors sedation and agitation in critical care
Richmond Agitation-Sedation Scale (RASS)
RASS
Monitors sedation and agitation in critical care
Instructions
The RASS is a validated tool used in intensive care units to assess the level of a patient’s agitation or sedation. Begin by observing the patient’s behavior. If the patient is not alert, call their name and observe eye contact. If unresponsive, provide physical stimulation (shoulder shake or sternal rub). The clinician assigns a score from +4 (combative) to -5 (unarousable) based on observed responsiveness. RASS should be assessed regularly to monitor sedation depth, adjust sedative medications, and ensure patient safety.
Overview
When to use
Why use
Evidences
Interpretation
Score | Description |
+4 | Combative: overtly violent, danger to staff |
+3 | Very agitated: pulls/removes tubes, aggressive |
+2 | Agitated: frequent non-purposeful movement, fights ventilator |
+1 | Restless: anxious, not aggressive |
0 | Alert and calm |
-1 | Drowsy: not fully alert, sustained eye contact >10 sec |
-2 | Light sedation: briefly awakens, eye contact <10 sec |
-3 | Moderate sedation: movement/eye opening to voice, no eye contact |
-4 | Deep sedation: movement/eye opening to physical stimulation only |
-5 | Unarousable: no response to voice or physical stimulation |
The Richmond Agitation–Sedation Scale (RASS) is a 10-point scale from +4 (combative) to −5 (unarousable), developed by a multidisciplinary ICU team and validated for interrater reliability and validity across medical and surgical ICU populations, including ventilated and non‑ventilated patients
https://jamanetwork.com/journals/jama/fullarticle/196696
The original validation reported excellent interrater reliability (e.g., r≈0.96; κ≈0.73–0.80) and strong correlations with visual analog scales and other sedation scales (Ramsay, SAS), supporting construct and criterion validity and ease of use by nurses and physicians
https://pubmed.ncbi.nlm.nih.gov/12421743/
Multicenter pediatric studies found excellent interrater reliability (weighted κ≈0.83–0.95) and strong correlations with COMFORT‑B and numeric rating scales, supporting RASS as a valid tool for sedation/agitation monitoring in PICUs, with responsiveness to sedative dose changes
https://pmc.ncbi.nlm.nih.gov/articles/PMC5080705/
Critical care guidelines endorse RASS (or SAS) as the primary bedside tool to assess depth of sedation in ICU patients; when deep sedation or neuromuscular blockade precludes behavioral scales, EEG/BIS may supplement assessment
Overview
When to use
Why use
Evidences
The Richmond Agitation-Sedation Scale (RASS) is a simple 10-point scale developed to standardize the assessment of patient consciousness and sedation in the ICU. It helps clinicians monitor patients receiving mechanical ventilation or sedative infusions and ensures that sedation is neither too deep (causing complications such as prolonged ventilation) nor too light (leading to agitation or accidental device removal).
RASS is widely validated across different patient groups, including medical, surgical, and trauma patients, and is often used in conjunction with delirium screening tools such as the CAM-ICU. It offers consistency in sedation titration, enhances patient safety, and improves communication among care teams.
Overview
When to use
Why use
Evidences
Interpretation
Score | Description |
+4 | Combative: overtly violent, danger to staff |
+3 | Very agitated: pulls/removes tubes, aggressive |
+2 | Agitated: frequent non-purposeful movement, fights ventilator |
+1 | Restless: anxious, not aggressive |
0 | Alert and calm |
-1 | Drowsy: not fully alert, sustained eye contact >10 sec |
-2 | Light sedation: briefly awakens, eye contact <10 sec |
-3 | Moderate sedation: movement/eye opening to voice, no eye contact |
-4 | Deep sedation: movement/eye opening to physical stimulation only |
-5 | Unarousable: no response to voice or physical stimulation |
The Richmond Agitation–Sedation Scale (RASS) is a 10-point scale from +4 (combative) to −5 (unarousable), developed by a multidisciplinary ICU team and validated for interrater reliability and validity across medical and surgical ICU populations, including ventilated and non‑ventilated patients
https://jamanetwork.com/journals/jama/fullarticle/196696
The original validation reported excellent interrater reliability (e.g., r≈0.96; κ≈0.73–0.80) and strong correlations with visual analog scales and other sedation scales (Ramsay, SAS), supporting construct and criterion validity and ease of use by nurses and physicians
https://pubmed.ncbi.nlm.nih.gov/12421743/
Multicenter pediatric studies found excellent interrater reliability (weighted κ≈0.83–0.95) and strong correlations with COMFORT‑B and numeric rating scales, supporting RASS as a valid tool for sedation/agitation monitoring in PICUs, with responsiveness to sedative dose changes
https://pmc.ncbi.nlm.nih.gov/articles/PMC5080705/
Critical care guidelines endorse RASS (or SAS) as the primary bedside tool to assess depth of sedation in ICU patients; when deep sedation or neuromuscular blockade precludes behavioral scales, EEG/BIS may supplement assessment
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