Adult RASS Assessment (Richmond Agitation–Sedation Scale)
Describe adult observed agitation or sedation with the original RASS assessment sequence.
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About
Adult RASS follows the original observed sequence: first agitation or alertness, then response to voice when the person is not alert, then physical stimulation only when there is no response to voice. It is an assessment descriptor, not a direct score picker. [1, 2]
The form records the observations that justify a descriptor rather than asking a user to choose +4 through −5. A not-assessable path withholds calculation when the sequence cannot be completed reliably; it is a software safety state, not another RASS level. [1]
Interpretation
| Score | Original term | Original description |
|---|---|---|
| +4 | Combative | Overtly combative or violent; immediate danger to staff. |
| +3 | Very agitated | Pulls/removes tubes or catheters; aggressive. |
| +2 | Agitated | Frequent non-purposeful movement or ventilator dyssynchrony. |
| +1 | Restless | Anxious or apprehensive, not aggressive or vigorous. |
| 0 | Alert and calm | Alert and calm. |
| −1 | Drowsy | Sustained eye contact to voice (>10 seconds). |
| −2 | Light sedation | Brief eye contact to voice (<10 seconds). |
| −3 | Moderate sedation | Movement or eye opening to voice, no eye contact. |
| −4 | Deep sedation | No response to voice; movement or eye opening to physical stimulation. |
| −5 | Unarousable | No response to voice or physical stimulation. |
The table describes the original ten-level adult scale; QuickMedCalc does not add not-assessable as an eleventh level. [1]
RASS observation sequence, assessability, and static ICU context
Why the page uses an assessment sequence
RASS is an observed descriptor, not a number-selection exercise. The original adult validation uses a fixed sequence: record spontaneous agitation or alertness first, assess response to voice when the person is not alert, and use physical stimulation only when there is no response to voice. The sequence preserves the observation that supports the final descriptor. [1, 2]
Not-assessable is a safety state, not an RASS level
The original adult RASS scale has ten levels from +4 through −5. QuickMedCalc uses not-assessable to withhold a score when the required response cannot be assessed reliably; it is not an eleventh level, and it is not silently converted to −5. [1]
Ventilation and specific assessment barriers
Mechanical ventilation or an endotracheal tube alone does not make a RASS assessment unassessable; the original adult validation included ventilated and non-ventilated ICU patients. Assessment may instead be limited by a specific barrier such as neuromuscular blockade, severe neurologic dysfunction, inability to observe the required response, communication barriers, or another condition that prevents a reliable sequence. [1, 2]
Adult implementation and pediatric validation
This implementation is limited to adult critical-care assessments. RASS itself has also been studied and validated in critically ill children, but this page does not provide pediatric interpretation or replace local pediatric assessment protocols. [1, 7]
Static PADIS context — not calculated
The 2018 PADIS guideline suggests light rather than deep sedation for appropriate mechanically ventilated adults. RASS does not set a universal target; the target depends on the person, treatment purpose, and applicable protocol. [3, 5]
The 2025 focused update conditionally suggests dexmedetomidine over propofol when light sedation and/or reducing delirium is the highest priority. This is static guideline context only: this page does not choose a medicine, dose, or target score. [4, 6]
References
- Sessler CN, 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. DOI 10.1164/rccm.2107138.
- Ely EW, et al. Monitoring sedation status over time in ICU patients. JAMA. 2003;289(22):2983–2991. PMID 12799407. DOI 10.1001/jama.289.22.2983.
- Devlin JW, et al. PADIS guideline. Crit Care Med. 2018;46(9):e825–e873. PMID 30113379. DOI 10.1097/CCM.0000000000003299.
- Lewis K, et al. Focused PADIS update. Crit Care Med. 2025;53(3):e711–e727. PMID 39982143. DOI 10.1097/CCM.0000000000006574.
- SCCM. Adult ICU PADIS guidance.
- SCCM. Focused PADIS update.
- Kerson AG, DeMaria R, Mauer E, et al. Validity of the Richmond Agitation-Sedation Scale (RASS) in critically ill children. Journal of Intensive Care. 2016;4:65. PMID 27800163. PMCID PMC5080705. DOI 10.1186/s40560-016-0189-5.
FAQ
The page returns a not-calculable assessment. QuickMedCalc treats not-assessable as a safety state, not as an eleventh RASS level; it does not map uncertainty to −5 or display a partial score.
Sources: [1]
Observed arousal can change over time. Interpret a documented RASS value with the assessment conditions, trends, and the complete clinical context.
Sources: [2]
This implementation is limited to adult critical-care assessments. RASS itself has pediatric validation, but this page does not provide pediatric interpretation or replace local pediatric protocols.
Sources: [7]
Both describe sedation, but RASS includes explicit agitation levels and a defined observation-to-stimulation sequence. They are not interchangeable labels.
Sources: [1]
Mechanical ventilation or an endotracheal tube alone does not automatically make RASS unassessable; the original adult validation included ventilated patients. Specific barriers such as neuromuscular blockade, severe neurologic dysfunction, inability to observe the required response, communication barriers, or stimulation conditions can limit a reliable assessment.
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Disclaimer
Educational and informational reference only. Not intended to replace professional medical advice, diagnosis, treatment, or independent verification.