RASS

Assess level of sedation and agitation in ICU patients. Target-directed sedation reduces ICU length of stay and improves outcomes.

Indication

Assess level of sedation and agitation in ICU patients. Target-directed sedation reduces ICU length of stay and improves outcomes.

id: rass; label: Observed level; type: options; options: value: 4; label: +4 Combative — violent, immediate danger to staff; value: 3; label: +3 Very agitated — pulls/removes tubes, aggressive; value: 2; label: +2 Agitated — frequent non-purposeful movement, fights vent; value: 1; label: +1 Restless — anxious, movements not aggressive; value: 0; label: 0 Alert and calm; value: -1; label: -1 Drowsy — sustained awakening (>10 s) to voice; value: -2; label: -2 Light sedation — briefly awakens (<10 s) to voice; value: -3; label: -3 Moderate sedation — movement/eye opening to voice, no contact; value: -4; label: -4 Deep sedation — responds only to physical stimulation; value: -5; label: -5 Unarousable — no response to voice or physical stimulation

function(score) { var disp = score > 0 ? '+' + score : '' + score; if (score >= 2) return { risk: 'RASS ' + disp, tier: 'Agitated / Under-sedated', action: 'Assess for pain and delirium first. Treat the cause; increase sedation if appropriate. Analgesia-first approach.', color: 'red' }; if (score === 1) return { risk: 'RASS ' + disp, tier: 'Restless', action: 'Anxious but not aggressive. Reassess; address pain/anxiety. Most ICU patients target RASS -1 to 0.', color: 'yellow' }; if (score === 0) return { risk: 'RASS ' + disp, tier: 'Alert & Calm', action: 'Ideal for most ICU patients and for daily awakening trials.', color: 'green' }; if (score >= -2) return { risk: 'RASS ' + disp, tier: 'Light Sedation', action: 'Target range for most ventilated patients. Propofol or dexmedetomidine preferred.', color: 'green' }; if (score === -3) return { risk: 'RASS ' + disp, tier: 'Moderate Sedation', action: 'Acceptable for specific situations (e.g. ARDS). Reassess need; consider lightening.', color: 'yellow' }; return { risk: 'RASS ' + disp, tier: 'Deep Sedation / Over-sedated', action: 'Reduce or hold sedation unless deep sedation is specifically indicated. Associated with worse cognitive outcomes.', color: 'red' }; }

Analgesia-first (treat pain before adding sedation) reduces sedation requirements
Daily spontaneous awakening trials reduce ventilator days
Combine RASS with CAM-ICU for delirium assessment
Lighter sedation targets are associated with better long-term cognitive outcomes