Chart — Critical Care
Sedation & Agitation Scales Chart
Sedation is titrated to a number, and two validated scales carry that job at the bedside — the Richmond Agitation-Sedation Scale and the Riker Sedation-Agitation Scale. They do not map onto each other one-to-one, so this chart lays out each one level by level, with the target range and a reminder to pair them with a delirium screen.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Richmond Agitation-Sedation Scale (RASS)
| Score | Term | Description |
|---|---|---|
| +4 | Combative | Overtly combative or violent; danger to staff |
| +3 | Very agitated | Pulls or removes tubes or catheters; aggressive |
| +2 | Agitated | Frequent non-purposeful movement; fights the ventilator |
| +1 | Restless | Anxious, apprehensive, but movement not aggressive |
| 0 | Alert and calm | — |
| −1 | Drowsy | Not fully alert; sustained (>10 s) awakening with 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 | No response to voice; movement or eye opening to physical stimulation |
| −5 | Unarousable | No response to voice or physical stimulation |
Riker Sedation-Agitation Scale (SAS)
| Score | Term | Description |
|---|---|---|
| 7 | Dangerous agitation | Pulling at ETT/catheters, climbing over rail, striking staff |
| 6 | Very agitated | Requires restraint and frequent verbal reminding of limits; bites ETT |
| 5 | Agitated | Anxious or mildly agitated, calms to verbal instruction |
| 4 | Calm and cooperative | Calm, awakens easily, follows commands |
| 3 | Sedated | Difficult to arouse but awakens to verbal stimuli or gentle shaking |
| 2 | Very sedated | Arouses to physical stimuli but does not communicate or follow commands |
| 1 | Unarousable | Minimal or no response to noxious stimuli |
Clinical Notes
- Aim for light sedation. The usual target for a ventilated patient is light sedation — a RASS of 0 to −2, or an SAS of 4. Deeper sedation is reserved for specific indications.
- Pair scoring with a delirium screen. A sedation score measures depth, not delirium. Pair it with a validated delirium screen such as the CAM-ICU — the ICU sedation and analgesia guide walks through how the two fit together.
- Lightest safe sedation wins. The goal is the lightest level of sedation that keeps the patient safe and comfortable — not the deepest the drug can reach.
Related Resources
Sources
- Sessler CN, Gosnell MS, Grap MJ, 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.
- Devlin JW, Skrobik Y, Gélinas C, et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU (PADIS). Crit Care Med. 2018;46(9):e825-e873.