Richmond Agitation Sedation Scale

The Richmond Agitation Sedation Scale (also in different spellings such as Richmond Agitation-Sedation Scale or Richmond Agitation-Sedation-Scale ; abbreviation RASS ) is a ten-point scale for assessing the depth of sedation . It is considered the medical gold standard . The RASS was developed by an interdisciplinary working group at the University of Richmond, Virginia .

application

The application is based on the clinical assessment of the patient. It is recommended at least every eight hours in intensive care units. It is supplemented by an assessment of the pain therapy on a suitable scale ( numerical rating scale , visual analogue scale , behavioral pain scale ). It also forms the basis for delirium monitoring in intensive care units and is included in the common assessment tool CAM-ICU (Confusion Assessment Method for the Intensive Care Unit). There is a translation into Swiss Standard German . The extension of level –6 contained there allows the additional differentiation of the lowest level for very deep sedation. Patients who do not respond to the gentler physical stimulation of shaking the shoulder are rubbed on the sternum.

gradation

value	designation	Explanation
+ 4	Argumentative	Obviously aggressive or violent, imminent danger to staff
+ 3	Very agitated	Pulls or removes tubes or catheters, or behaves aggressively towards personnel
+ 2	Agitated	Frequent undirected movement, breathing against the ventilator
+ 1	Restless	Anxious but not aggressive or agile movements
0	Mindful and calm
- 1	Sleepy	Not very attentive, but wakes up continuously (longer than 10 seconds), with eye contact, when spoken to
- 2nd	Light sedation	Wakes up briefly (less than 10 seconds) with eye contact when spoken to
- 3	Moderate sedation	Any movement (but without eye contact) when spoken to
- 4th	Deep sedation	No response to being spoken to, but some movement to physical stimulus
- 5th	Not awakenable	No response to speech or physical stimulus

execution

Observe the patient. Is he awake and calm (Score 0)? Or is the patient restless or agitated (score +1 to +4 according to the respective description)?
If the patient is awake, speak by name in a loud voice and ask the patient to open their eyes and look at the speaker. How long can the patient maintain eye contact?
- Patient wakes up with continued eye opening and eye contact. (Score -1)
- Patient wakes up with open eyes and eye contact, but not persistently. (Score –2)
- Patient shows some movement when spoken to, but no eye contact. (Score -3)
If the patient does not respond to the speech, stimulate the patient physically by shaking the shoulders or - if this does not help - by rubbing the sternum .
- Patient shows some movement in response to physical stimulus. (Score -4)
- Patient shows no response to any stimulus. (Score -5)

At the end you get a number between −5 and +4. No invoice is necessary.

It is important to measure at least every 6 hours and as necessary to detect changes in sedation or opioid therapy.

reliability

The RASS has been tested for validity and reliability in intensive care patients, shows a high degree of agreement among different examiners ( interrater reliability ) and adequately reflects changes in the depth of sedation over the course of the study. The S3 guideline of the German specialist societies on analgesia, sedation and delirium management in intensive care medicine recommends the RASS as the standard; it is considered superior to the Ramsay score .

Individual evidence

↑ ^a ^b ^c S3 guideline for analgesia, sedation and delirium management in intensive care medicine of the DGAI and DIVI . In: AWMF online (as of August 31, 2015)
↑ CN Sessler, MJ Grap, GM: Brophy Multidisciplinary management of sedation and analgesia in critical care . In: Semin Respir Crit Care Med. , 2001, 22 (2), pp. 211-226, PMID 16088675 .
↑ ^a ^b CN Sessler et al .: The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients . In: Am J Respir Crit Care Med. , 2002 Nov 15, 166 (10), pp. 1338-1344, PMID 12421743 .
↑ Ursi Barandun Schäfer, Paola Massarotto, Angelika Lehmann, Christoph Wehrmüller, Rebecca Spirig, Stephan Marsch: Translation process for a clinical assessment instrument using the Richmond Agitation-Sedation Scale (RASS) as an example . In: Pflege , 2009 Feb, 22 (1), pp. 7-17, doi: 10.1024 / 1012-5302.22.1.7 , PMID 19173174 .

^ EW Ely et al .: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS) . In: JAMA , 2003 Jun 11, 289 (22), pp. 2983-2991, PMID 12799407 .

[S3LL-1] S3 guideline for analgesia, sedation and delirium management in intensive care medicine of the DGAI and DIVI . In: AWMF online (as of August 31, 2015)

[2] CN Sessler, MJ Grap, GM: Brophy Multidisciplinary management of sedation and analgesia in critical care . In: Semin Respir Crit Care Med. , 2001, 22 (2), pp. 211-226, PMID 16088675 .

[sessler2-3] CN Sessler et al .: The Richmond Agitation-Sedation Scale: validity and reliability in adult intensive care unit patients . In: Am J Respir Crit Care Med. , 2002 Nov 15, 166 (10), pp. 1338-1344, PMID 12421743 .

[4] Ursi Barandun Schäfer, Paola Massarotto, Angelika Lehmann, Christoph Wehrmüller, Rebecca Spirig, Stephan Marsch: Translation process for a clinical assessment instrument using the Richmond Agitation-Sedation Scale (RASS) as an example . In: Pflege , 2009 Feb, 22 (1), pp. 7-17, doi: 10.1024 / 1012-5302.22.1.7 , PMID 19173174 .

[5] EW Ely et al .: Monitoring sedation status over time in ICU patients: reliability and validity of the Richmond Agitation-Sedation Scale (RASS) . In: JAMA , 2003 Jun 11, 289 (22), pp. 2983-2991, PMID 12799407 .