Observed level
+4 · Combative — violent, immediate danger to staff
+3 · Very agitated — pulls at tubes/catheters, aggressive
+2 · Agitated — frequent non-purposeful movement, fights ventilator
+1 · Restless — anxious, movements not aggressive
−1 · Drowsy — sustained (> 10 s) awakening, eye contact to voice
−2 · Light sedation — briefly (< 10 s) awakens with eye contact to voice
−3 · Moderate sedation — movement or eye opening to voice, no eye contact
−4 · Deep sedation — responds only to physical stimulation
−5 · Unarousable — no response to voice or physical stimulation
Evidence
Original publication
Sessler CN, Gosnell MS, Grap MJ, et al. The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients. A 10-point scale (+4 combative to −5 unarousable) with high inter-rater reliability and construct validity against sedative dosing and level of consciousness.
American Journal of Respiratory and Critical Care Medicine, 2002
Validation
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. The RASS detected changes in sedation level over consecutive days and correlated with attention testing and Glasgow Coma Scale.
JAMA, 2003
Guideline
The SCCM PADIS guidelines recommend targeting light sedation (often RASS −2 to 0) with a validated scale such as the RASS, paired with daily sedation interruption or nurse-driven protocols.
Last reviewed: 2026-09
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MedScore is an educational and clinical decision-support tool. It does not provide a diagnosis, a treatment, or a drug-dosing recommendation, and it does not replace clinical judgement or local guidelines. Confirm every result against the original source before acting on it. The treating clinician remains responsible for all decisions.