What is the RASS scoring procedure?

Step 1: Observe the patient for 30 seconds — if awake and exhibiting combative, very agitated, agitated, or restless behavior, score +1 to +4 accordingly. Step 2: If no spontaneous alertness, call patient's name and ask to open eyes — if eyes open and make contact score 0 (alert); if eyes open without sustained contact score -1; if any eye movement or voice response but no eye contact score -2. Step 3: If no voice response, apply physical stimulation (shoulder shake or sternal rub) — response without voice scores -3; movement only scores -4; no response scores -5.

Why is lighter sedation (RASS -1 to 0) preferred in most ICU patients?

Landmark trials (MENDS, SLEAP, eCASH) demonstrated that targeting light sedation (RASS -1 to 0) rather than deep sedation reduces duration of mechanical ventilation, ICU length of stay, long-term cognitive impairment, and post-ICU PTSD. Deep sedation (RASS -3 to -4) is associated with ICU-acquired weakness, delirium, and impaired post-ICU functional recovery. Deep sedation should be reserved for specific indications (neuromuscular blockade, severe ICP elevation, refractory status epilepticus).

Richmond Agitation-Sedation Scale (RASS)

Score agitation and sedation depth using the RASS (-5 to +4). Target RASS -1 to 0 for most ICU patients to reduce ventilator days, delirium, and ICU-acquired weakness.

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Richmond Agitation-Sedation Scale (RASS)

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Frequently Asked Questions

What is the RASS scoring procedure?

Why is lighter sedation (RASS -1 to 0) preferred in most ICU patients?