Table 3 Sedation and sedation-agitation scales

Ramsay Sedation Scale (RSS; 1974) [35]

Six levels: four levels of sedation defined by responses to stimuli (levels 3 to 6), a level of 'cooperative, oriented, and tranquil' (level 2), and a level for 'anxious, agitated, or restless' (level 1)

K = 0.94, RNs [58]

Versus RASS (r = -0.78) [39]

Versus BIS (P < 0.01) [63]

Versus BIS v2.10 (r = -0.27) [64]

Versus BIS XP v3.10 (r = -0.40) [64]

Sedation Agitation Scale (SAS; 1994) [85]

Seven levels: three levels of agitation (levels 5 to 7), a 'calm and cooperative' level (level 4), and three levels of sedation (levels 1 to 3). All levels are defined by multiple (3 or 4) criteria

r² = 0.83, K = 0.92 [36]

Versus RSS (r² = 0.83) [36]

K = 0.93 [59]

Versus VAS sedation r = -0.77) [59]

K = 0.85 investigators [59]

Versus Harris (r² = 0.86) [36]

K = 0.87 RNs [59]

Versus BIS (r² = 0.21) [65]

Versus VAS, researcher (r = 0.9) [61]

Versus VAS, nurses (r = 0.43) [61]

Versus BIS 3.2 (r = 0.6) [61]

Versus BIS (r = 0.36) [66]

Versus BIS, exclude motor excess (r = 0.50) [66]

Versus BIS (r² = 0.48 before, 0.44 after stimulation) [67]

Versus digital imaging [70]

Versus BIS XP (r = 0.725) [68]

Versus BIS v2.1.1 (r = 0.376) [68]

Motor Activity Assessment Scale (MAAS; 1999) [37]

Seven levels: three levels of agitation (levels 4 to 6), a 'calm and cooperative' level (level 3), and three Levels of sedation (levels 0 to 2). All levels are defined by multiple (3 to 4) criteria

K = 0.83 (95% CI 0.72 to 0.94) [37]

Versus VAS (P = 0.001) [37]

r = 0.81, 3RN, 1MD, 1PharmD [60]

Versus BP (P = 0.001) [37]

Versus HR (P = 0.001) [37]

Versus agitation-related sequelae (P = 0.001) [37]

Vancouver Interactive and Calmness Scale (2000) [38]

Contains two domains ('interaction' and 'calmness'). Each domain has five questions, and each question has six responses from 'strongly agree' to 'strongly disagree'. Patient stimulation required for some questions. Scores are summed (maximum 30/domain), with higher scores for calm and interactive

r = 0.89 for calmness score

Calmness score versus need for intervention r = -0.83 [38]

r = 0.90 for interactive score

Minimal clinical important difference, calmness = -2.2 [38]

Minimal clinical important difference, interaction = 2.5 [38]

Guyatt's responsiveness statistic, calmness = -1.4 [38]

Guyatt's responsiveness statistic, interaction = 2.3 [38]

Richmond Agitation – Sedation Scale (RASS; 2002) [39]

Ten level scale: four levels of agitation (levels +1 to +4), a level for 'calm and alert' (level 0), and five levels of sedation (-1 to -5) defined by response to verbal then physical stimulation, plus consideration of cognition and sustainability

r = 0.956. K = 0.73 for five raters (2 MD, 2 RN, and 1 PharmD) [39]

Versus VAS r = 0.93 (95% CI 0.84 to 0.98) [39]

r = 0.964, K = 0.80 nurse educator versus 27 RNs [39]

Versus GCS (r = 0.79) [39]

K = 0.91 RN [58]

Versus RSS (r = -0.78) [39]

K = 0.89 RN versus rater [90]

Versus SAS (r = 0.78) [39]

K = 0.77 RN versus rater [90]

Differences in consciousness (P < 0.001) [58]

Fluctuation in consciousness (P < 0.001) [58]

Versus attention screening (r = 0.78) [58]

Versus GCS (r = 0.91) [58]

Versus quantity of Rx (r = -0.31) [58]

Versus BIS (r = 0.63) [58]

Face validity 92% agreed [58]

Versus BIS XP (r = 0.81) [68]

Versus BIS v2.1.1 (r = 0.30) [68]

Versus BIS XP (r² = 0.36) [69]

Versus BIS 3.4 (r² = 0.20) [69]

Versus actigraphy (r = 0.58) [62]

Versus COMFORT scale (r = 0.75) [62]

Adaptation to Intensive Care Environment (ATICE; 2003) [40]

Five tests in two domains: consciousness and tolerance domains. Tests included in the consciousness domain: awakeness scale (five levels from 0 = eyes closed, no mimic, to 5 = eyes open spontaneously, based on verbal then physical stimulation) and comprehension scale (score based on summing 1 point each for positive response to five commands). Tests included in the tolerance domain: calmness scale (four levels from 3 = calm to 0 = life-threatening agitation), ventilator synchrony scale (score based on summing 1 point for each of four observed events) and face relaxation scale (four levels from 3 = relaxed face to 0 = permanent grimacing)

r = 0.86 to 0.99 RN versus MD [40]

Internal consistency = 0.67 to 0.87 [40]

r = 0.82 to 0.99 RN versus research RN [40]

Versus RSS (r = 0.40 to 0.86) [40]

r = 0.91 to 0.99 research RN versus MD [40]

Versus SAS (r = 0.37 to 0.75) [40]

Versus GCS (r = 0.78 to 0.95) [40]

Versus COMFORT scale (r = 0.38 to 0.83) [40]

Versus VAS (r = 0.41 to 0.92) [40]

Versus sedative plus analgesics (r = 0.45 to 0.72) [40]

Minnesota Sedation Assessment Tool (MSAT; 2004) [41]

Two domains: arousal and motor activity. Arousal is a six-level scale (1 = deeply sedated to 6 = alert) based on eye opening or movement responses to verbal then physical stimulation. Motor scale has four levels (1 = no movement to 4 = central muscle group movement)

Arousal scale K = 0.85 [41]

Arousal scale: r = 0.68 versus VICS [41]

Motor scale K = 0.72 [41]

Motor scale: r = -0.41 versus calmness subscale of VICS [41]

Convergent validity present for arousal and motor [41]

Predictive validity present for arousal only [41]