Unifying Concepts

Sedation Scales for Patients in the ICU

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



  1. Reade MC, Finfer S. Sedation and delirium in the intensive care unit. N Engl J Med. 2014 Jan 30;370(5):444-54. [Medline]
  2. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013 Jan;29(1):51-65. [Medline]
  3. 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]
  4. 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.

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