Richmond Agitation-Sedation Scale (RASS)
Riker Sedation-Agitation Scale (SAS)
7 | Dangerous agitation | Pulling at endotracheal tube, trying to remove catheters, climbing over bed rail, striking at staff, thrashing side to side |
6 | Very agitated | Does not calm, despite frequent verbal reminding of limits; requires physical restraints, biting endotracheal tube |
5 | Agitated | Anxious or mildly agitated, attempting to sit up, calms down to verbal instructions |
4 | Calm and cooperative | Calm, awakens easily, follows commands |
3 | Sedated | Difficult to arouse; awakens to verbal stimuli or gentle shaking, but drifts off again; follows simple commands |
2 | Very sedated | Arouses to physical stimuli, but does not communicate or follow commands, may move spontaneously |
1 | Unable to rouse | Minimal or no response to noxious stimuli, does not communicate or follow commands
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RASS vs. SAS
- Excellent reliability with both
- CAM-ICU based on RASS
- Presence and sustainability cognition or comprehension only with RASS
- Mechanical ventilation synchrony only with RASS
- RASS provide distinction despite the single scale design (- vs +)
Bispectral Index (BIS)
- Measures the electrical activity in the brain
- Range:
- 0 = COMPLETE absence of brain activity
- 100 = FULLY awake
- Values between 40 – 60 represent adequate general anesthesia and showed “very low levels of post-operation recall”
- Values less than 40 represent a deep hypnotic state
- <20 = burst suppression
BIS in The ICU
- PADIS guidelines: “BIS monitoring…during deep sedation or neuromuscular blockade”
- Low BIS associated with increasing delirium
- Morbidity and mortality?
- Possible faster wakening times
- Currently no high-level evidence to guide use in ICU