Free tool · Scored assessment · ICU
RASS — Richmond Agitation-Sedation Scale.
The standard bedside scale for how agitated or sedated an ICU patient is, from +4 (combative) through 0 (alert and calm) to −5 (unarousable). Pick the level you observe and get the plain read, where it sits against the usual light-sedation target, and whether the patient is arousable enough to screen for delirium with CAM-ICU. The scale follows Sessler 2002; the sedation-target context follows the SCCM PADIS guideline. It supports your assessment and the sedation orders — it doesn't replace them.
Pick the observed level
Assess in steps: observe the patient; if not alert, say their name and ask them to open their eyes and look at you; if still no response, physically stimulate (shake the shoulder, then rub the sternum). Score the patient's best response.
Select the level you observe to see the read.
Quick reference [1]
+1 to +4 = agitation (escalating). 0 = alert and calm. −1 to −2 = light sedation (a common target). −3 = moderate sedation. −4 to −5 = deep sedation / unarousable.
The SCCM PADIS guideline recommends targeting light sedation in most mechanically ventilated adults (commonly a RASS around 0 to −2) rather than deep sedation, unless clinically contraindicated.[3] Delirium screening with CAM-ICU is performed when the patient is arousable to voice — a RASS of −3 or higher; at −4 or −5 the patient is too sedated to assess, so re-check later.[2] Your unit's sedation goal and orders take precedence.
References
- Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. Am J Respir Crit Care Med. 2002;166(10):1338–1344. PMID: 12421743. (Original 10-level scale; level terms and behavioral descriptors transcribed from this instrument.)
- Ely EW, Truman B, Shintani A, et al. Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS). JAMA. 2003;289(22):2983–2991. PMID: 12799407. (RASS used with CAM-ICU; delirium screened at RASS ≥ −3.)
- Devlin JW, Skrobik Y, Gélinas C, et al. Clinical Practice Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU (PADIS). Crit Care Med. 2018;46(9):e825–e873. PMID: 30113379. (Targeting light sedation over deep sedation in mechanically ventilated adults.)
Level terms and descriptors were transcribed from the validated RASS; sedation-target context is from the SCCM PADIS guideline. Your unit's sedation protocol takes precedence at the bedside.
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