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RASS was designed to have precise, unambiguous definitions for levels of sedation that rely on an assessment of arousal, cognition, and sustainability using common responses common stimuli presented in a logical progression. To better use it these stimuli should presented to the patient as follows:
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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 Jun
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Curtis N. Sessler, Mark S. Gosnell, Mary Jo Grap, Gretchen M. Brophy, Pam V. O'Neal, Kimberly A. Keane, Eljim P. Tesoro, and R. K. Elswick "The
Richmond Agitation–Sedation Scale", American Journal of Respiratory and Critical Care Medicine, Vol. 166, No. 10 (2002), pp. 1338-1344. doi:
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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. Obtaining a RASS score is the first step in administering the
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If patient is not alert, in a loud speaking voice state patient's name and direct patient to open eyes and look at speaker. Repeat once if necessary. Can prompt patient to continue looking at speaker.
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The RASS is one of many sedation scales used in medicine. Other scales include the Ramsay scale, the
Sedation-Agitation-Scale, and the COMFORT scale for pediatric patients.
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If patient does not respond to voice, physically stimulate patient by shaking shoulder and then rubbing sternum if there is no response to shaking shoulder.
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level of a person. It was developed with efforts of different practitioners, represented by physicians, nurses and pharmacists.
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Does patient have behavior that is consistent with restlessness or agitation (score +1 to +4 using the criteria listed at the
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Stawicki SP "Sedation scales: Very useful, very underused", OPUS 12 Scientist, Vol. 1, No. 2 (2007), pp. 10-12.
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Not fully alert, but has sustained (more than 10 seconds) awakening, with eye contact, to voice
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Patient has eye opening and eye contact, which is sustained for more than 10 seconds (score -1).
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Patient has eye opening and eye contact, but this is not sustained for 10 seconds (score -2).
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Pulls on or removes tube(s) or catheter(s) or has aggressive behavior toward staff
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in the ICU (CAM-ICU), a tool to detect delirium in intensive care unit patients.
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Patient has any movement in response to voice, excluding eye contact (score -3).
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Patient has no response to voice or physical stimulation (score -5).
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Frequent nonpurposeful movement or patient–ventilator dyssynchrony
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Briefly (less than 10 seconds) awakens with eye contact to voice
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Anxious or apprehensive but movements not aggressive or vigorous
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No response to voice, but any movement to physical stimulation
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Patient has any movement to physical stimulation (score -4).
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Overtly combative or violent; immediate danger to staff
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Observe patient. Is patient alert and calm (score 0)?
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Medical scale used to measure agitation and sedation
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