Lesson 2 of 4
In Progress


Riszel March 9, 2022

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



  • 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