Of the sedation scales described, the Riker Sedation–Agitation Scale and the Richmond Agitation–Sedation Scale are the most commonly reported, but in head-to-head comparison, neither is demonstrably superior Sedation Scales for Patients in the intensive care unit (ICU).
Sedation Scales for Patients in the ICU
Riker Sedation–Agitation Scale (SAS) | ||
Scoring | Scale | Description |
score of 7 | Dangerous agitation | Pulling at endotracheal tube, trying to remove catheters, climbing over bed rail, striking at staff, thrashing from side to side |
score of 6 | Very agitated | Requiring restraint and frequent verbal reminding of limits, biting endotracheal tube |
score of 5 | Agitated | Anxious or physically agitated, calming at verbal instruction |
score of 4 | Calm and cooperative | Calm, easily rousable, follows commands |
score of 3 | Sedated | Difficult to arouse but awakens to verbal stimuli or gentle shaking; follows simple commands but drifts off again |
score of 2 | Very sedated | Arouses to physical stimuli but does not communicate or follow commands, may move spontaneously |
score of 1 | Cannot be aroused | Minimal or no response to noxious stimuli, does not communicate or follow commands |
Richmond Agitation–Sedation Scale (RASS) | ||
Scoring | Scale | Description |
score of 4 | Combative | Overtly combative, violent, immediate danger to staff |
score of 3 | Very agitated | Pulls or removes tubes or catheters; aggressive |
score of 2 | Agitated | Frequent non purposeful movement, fights ventilator |
score of 1 | Restless | Anxious but movements not aggressive or vigorous |
score of 0 | Alert and calm | Alert and calm |
score of -1 | Drowsy | Not fully alert but has sustained awakening (eye opening or eye contact) to voice (>/=10 sec) |
score of -2 | Light sedation | Briefly awakens with eye contact to voice (<10 sec) |
score of -3 | Moderate sedation | Movement or eye opening to voice but no eye contact |
score of -4 | Deep sedation | No response to voice but movement or eye opening to physical stimulation |
score of -5 | Cannot be aroused | No response to voice or physical stimulation |
References:
- Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014 Jan 30;370(5):444-54. [Medline]
- Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013 Jan;29(1):51-65. [Medline]
- Riker RR, Picard JT, Fraser GL. Prospective evaluation of the Sedation-Agitation Scale for adult critically ill patients. Crit Care Med. 1999 Jul;27(7):1325-9.[Medline]
- 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 Nov 15;166(10):1338-44. [Medline]
Created Feb 21, 2014.