|−2||Light sedation||Briefly (less than 10 seconds) awakens with eye contact to voice|
|−3||Moderate sedation||Any movement (but no eye contact) to voice|
|−4||Deep sedation||No response to voice, but any movement to physical stimulation|
|−5||Unarousable||No response to voice or physical stimulation|
The Richmond Agitation Sedation Scale ( RASS ) is an instrument designed to assess the level of alertness and agitated behavior in critically-ill patients.
One of the most commonly used measures of sedation is the Ramsay Sedation Scale . It divides a patient’s level of sedation into six categories ranging from severe agitation to deep coma. Despite its frequent use, the Ramsay Sedation Scale has shortcomings in patients with complex cases.
The Richmond Agitation and Sedation Scale ( RASS ) is a validated and reliable method to assess patients’ level of sedation in the intensive care unit. As opposed to the Glasgow Coma Scale (GCS), the RASS is not limited to patients with intracranial processes.
INTRODUCTION. In 2001, the Joint Commission developed a new definition of moderate sedation that is now widely accepted and used . The Joint Commission identifies moderate sedation /analgesia as the second level in a continuum between minimal sedation (i.e., anxiolysis) and deep sedation (i.e., anesthesia).
Levels of Sedation Minimal Sedation (anxiolysis) A drug-induced state during which patients respond normally to verbal commands. Moderate sedation . Deep sedation /analgesia. General anesthesia .
Sedation vacations are a balancing act of tightly titrating the sedative dose to provide agitation free, comfortable sedation on the lowest dosage possible. They are patient-specific, as various disease processes and patient tolerances necessitate different doses of medicine.
Sedation should be assessed, via the RASS score, and documented at least once every 2 hours while patients are mechanically ventilated. The guideline recommends a goal RASS score of “0 to −1” for most patients, although specific exceptions exist (ie, neuromuscular blockade).
The CAM – ICU score is a validated and commonly used score to help monitor patients for the development or resolution of delirium. It is an adaptation of the Confusion Assessment Method ( CAM ) score for use in ICU patients. In order for the CAM – ICU score to be accurate, patients should not be sedated, or have a RASS of 0.
It is a 10-point scale , with four levels of anxiety or agitation, one level denoting a calm and alert state, and 5 levels of sedation. On one extreme of the RASS score , +4 represents a very combative, violent patient, who is considered dangerous to the staff.
Certified Registered Nurse Anesthetists (CRNA’s), anesthesiologists, other physicians, dentists, and oral surgeons are qualified providers of conscious sedation . Specifically trained Registered Nurses may assist in the administration of conscious sedation .
The COMFORT scale is a valuable and reliable pain assessment tool for use in postoperative ventilated pediatric patients. It possesses internal consistency and is a reliable pain assessment tool for use in ventilated patients following cardiac surgery.
The Confusion Assessment Method for the Intensive Care Unit ( CAM – ICU ) is a tool used to assess delirium among patients in the intensive care unit . It is an adaptation of the CAM which was originally developed to allow non-psychiatrists to assess delirium at bedside.
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure. Examples of drugs which can be used for sedation include isoflurane, diethyl ether, propofol, etomidate, ketamine, pentobarbital, lorazepam and midazolam.
The CPOT includes evaluation of four different behaviors (facial expressions, body movements, muscle tension, and compliance with the ventilator for mechanically ventilated patients or vocalization for nonintubated patients) rated on a scale of zero to two with a total score ranging from 0 to 8.