Evaluating and monitoring analgesia and sedation in the intensive care unit

Table 5 Richmond Agitation-Sedation Scale

Score	Term	Description
+4	Combative	Overtly combative or violent, immediate danger to staff
+3	Very agitated	Pulls on or removes tube(s) or catheter(s) or exhibits aggressive behavior toward staff
+2	Agitated	Frequent nonpurposeful movement or patient-ventilator dys-synchrony
+1	Restless	Anxious or apprehensive but movements not aggressive or Vigorous
0	Alert and calm
-1	Drowsy	Not fully alert, but has sustained (>10 seconds) awakening, with eye contact, to voice
-2	Light sedation	Briefly (<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

Performed using a series of steps: observation of behaviors (score +4 to 0), followed (if necessary) by assessment of response to voice (score -1 to -3), followed (if necessary) by assessment of response to physical stimulation such as shaking shoulder and then rubbing sternum if no response to shaking shoulder (score -4 to -5) [39].

ISSN: 1364-8535