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Assess sedation and agitation levels in critically ill patients
Awake, aware, following commands, comfortable
Alert and calm to drowsy. Allows for communication and assessment.
Light sedation to alert. Facilitates ventilator synchrony and weaning.
Deep sedation only when specifically indicated.
| Score | Term | Description | Assessment |
|---|---|---|---|
| +4 | Combative | Violent, danger to staff | Observe behavior |
| +3 | Very Agitated | Pulls tubes, aggressive | Observe behavior |
| +2 | Agitated | Nonpurposeful movement, dyssynchrony | Observe behavior |
| +1 | Restless | Anxious, not aggressive | Observe behavior |
| 0 | Alert & Calm | Spontaneously attentive | Observe behavior |
| -1 | Drowsy | Eye opening ≥10 sec to voice | Verbal stimulation |
| -2 | Light Sedation | Eye opening <10 sec to voice | Verbal stimulation |
| -3 | Moderate Sedation | Movement to voice, no eye opening | Verbal stimulation |
| -4 | Deep Sedation | Movement to physical stimulus only | Physical stimulation |
| -5 | Unarousable | No response to any stimulus | Physical stimulation |
Wake patient daily to assess neurologic status and readiness for extubation. Target RASS 0 to -1 during awakening trials.
RASS must be -3 or higher to assess for delirium using CAM-ICU. Cannot assess delirium in deeply sedated patients.
Spontaneous breathing trials require RASS -1 to 0. Lightening sedation is essential for successful extubation.
Nurse-driven sedation protocols using RASS targets improve outcomes and reduce ICU length of stay.
Before increasing sedation for positive RASS scores, always assess for pain, delirium, ventilator dyssynchrony, and unmet needs.
Deep sedation (RASS -4 to -5) increases risk of delirium, ICU-acquired weakness, prolonged mechanical ventilation, and mortality.
RASS cannot be assessed in paralyzed patients. Ensure adequate sedation before and during neuromuscular blockade. Use train-of-four monitoring.
Document RASS score every 2-4 hours in ICU patients. More frequent assessment during sedation titration or when agitated.
RASS is a validated 10-point scale to assess sedation and agitation levels in ICU patients. It guides sedation management, helps prevent over-sedation, and is required for delirium screening. RASS assessment is standard of care in critical care.
For most ICU patients, target RASS is 0 to -2 (alert to light sedation). This allows for communication, neurologic assessment, and ventilator weaning while maintaining comfort. Deeper sedation should only be used when specifically indicated.
RASS should be assessed every 2-4 hours in stable ICU patients, more frequently (every 15-60 minutes) during sedation titration or in agitated patients. Always document RASS before administering PRN sedatives.
Positive RASS scores indicate agitation. Before increasing sedation, assess for reversible causes: pain, delirium, full bladder, ventilator dyssynchrony, hypoxia, or withdrawal. Address underlying causes rather than automatically increasing sedatives.
Yes, RASS can be used in any ICU patient, intubated or not. It's useful for monitoring sedation from any cause (medications, illness, metabolic derangements) and for titrating sedatives in non-invasive ventilation or agitated patients.
CAM-ICU (delirium assessment) can only be performed when RASS is -3 or higher. If RASS is -4 or -5, patient is too sedated to assess for delirium. This is documented as "unable to assess" for CAM-ICU.
The RASS scale is a clinical assessment tool that requires proper training for accurate use. This calculator is for educational purposes and should not replace clinical judgment or formal training in RASS assessment. RASS scoring should be performed by qualified healthcare professionals in appropriate clinical settings. Always consider the full clinical context when interpreting RASS scores.