Sedation

A sedation scale answers, “How readily does this patient awaken and respond?” It does not explain why the patient is difficult to arouse. An intubated patient who does not open the eyes may be deeply sedated, but the same finding can result from hypercapnia, hypoglycemia, a postictal state, or acute neurologic injury. The score must therefore be paired with airway, breathing, circulation, medication, and neurologic assessment. The Richmond Agitation-Sedation Scale (RASS) is a validated, recommended tool for assessing sedation in adult ICU patients. Record it at least once per nursing shift and more often when the patient’s condition, medication infusion, or sedation target changes. A consistent scale gives the team a shared language: “RASS -4” communicates more useful information than “very sleepy.” Sedatives reduce activity in the brain’s arousal networks in a dose-dependent manner. As the effect increases, the patient progresses from calm wakefulness to brief response to voice, response only to physical stimulation, and finally no response. A low score is not automatically therapeutic; it is therapeutic only when it matches the prescribed goal and the patient remains physiologically...