Richmond Agitation Sedation Scale (RASS)
Assesses the degree of sedation or agitation in hospitalized patients.
You can read more about the interpretation of the RASS score and the results in the text below the calculator.
The Richmond Agitation Sedation Scale evaluates sedation in patients who are hospitalized, respectively their level of agitation prior to being sedated.
The original study has been followed by numerous validation studies. The scale presented an excellent inter-rater reliability in the ICU setting.
In the RASS there are 10 patient statuses from which the evaluator can choose.
■ The highest score is 4 and the lowest is -5.
■ For alert and calm patients, RASS is 0.
■ For agitated patients, scores are positive and the higher the score, the higher the agitation level.
■ For sedated patients, scores are negative, where -5 points indicate unarousable sedation.
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Patient status descriptions
In order to assess the level of agitation or sedation of the patient, clinicians are advised to observe the patient and test responses to verbal and pain stimulation.
The following table introduces the patient status descriptions as they are understood in the use of the above Richmond agitation sedation scale:
| Patient status (points) | Description |
| Combative (4) | Patient is overtly combative, violent and an immediate danger to staff. |
| Very Agitated (3) | Patient pulls or removes tube(s) or catheter(s) and/ or is being aggressive. |
| Agitated (2) | Patient presents frequent non-purposeful movement and also fights ventilator risking self-extubating or ventilator dyssynchrony. |
| Restless (1) | Patient is anxious, movements are vigorous but not aggressive. |
| Alert and Calm (0) | Patient is cooperative and sedated properly. |
| Drowsy (-1) | Patient is not fully alert, but has sustained awakening (eye-opening/eye contact) to voice for more than 10 seconds. |
| Light Sedation (-2) | Patient briefly awakens with eye contact to voice but for less than 10 seconds. |
| Moderate Sedation (-3) | Patient does present some movement or eye opening to voice but no eye contact. |
| Deep Sedation (-4) | Patient has no response to voice, but movement or eye opening to physical stimulation. |
| Unarousable Sedation (-5) | Patient has no response to voice or physical stimulation. |
RASS score interpretation
The Richmond scale consists of the above described 10 patient statuses. Each status has its own score, either positive, zero or negative. The interpretation of that score is:
■ RASS scores of 1 and above indicate that the patient is in an agitated state, is not sedated enough and should be monitored in case displays pain, anxiety and other symptoms.
■ RASS scores between -2 and 0 indicate a patient who is sedated properly therefore can be cooperative but also not in pain or agitation. This is the sedation score interval that should be aimed for.
■ Scores below -2 indicate the patient is sedated too much and that sedative medication should be decreased.
About the original study
The RASS was created in the Virginia Commonwealth University in Richmond as a mean to reduce intravenous use of medication in ICU.
It was also found that proper selection reduces the patient stay in the intensive care unit and reduces requirement for mechanical ventilation.
The American Society of Anesthesia proposes the following sedation levels: minimal, moderate, deep and general.
Although the RASS does not work under these guidelines, the two methods can be used jointly to increase the accuracy of patient monitoring.
Although the RASS does not offer precise information on the outcome, it can direct clinicians whether to increase or decrease sedation medication.
It often precedes the Confusion Assessment Method, which is a method of delirium assessment in ICU patients.
Dr Curtis Sessler is a professor at Virginia Commonwealth University (VCU) Health System. His research focuses on ICU sedation amongst others.
Original source
Sessler CN, Grap MJ, Brophy GM. Multidisciplinary management of sedation and analgesia in critical care. Semin Respir Crit Care Med. 2001; 22(2):211-26.
Validation studies
1. Sessler CN, Gosnell MS, Grap MJ, Brophy GM, O'Neal PV, Keane KA, Tesoro EP, Elswick RK. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002; 166(10):1338-44.
2. Ely EW, Truman B, Shintani A, Thomason JW, Wheeler AP, Gordon S, Francis J, Speroff T, Gautam S, Margolin R, Sessler CN, Dittus RS, Bernard GR. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003; 289(22):2983-91.
Specialty: Psychiatry
System: Nervous
Objective: Evaluation
No. Of Items: 10
Year Of Study: 2001
Abbreviation: RASS
Article By: Denise Nedea
Published On: March 16, 2017 · 10:10 AM
Last Checked: March 16, 2017
Next Review: March 10, 2023