Ramsay Sedation Scale
Assesses sedation depth in mechanically ventilated ICU patients on a 6-point scale. Predecessor to RASS. Target level typically 2–3 for most ICU patients.
Score interpretation
Patient anxious, agitated, restless. Sedation inadequate or under-dosed.
→ Assess for pain (CPOT scale), delirium (CAM-ICU), and reversible causes (catheter discomfort, ETT, bladder). Titrate sedation. Consider analgo-sedation approach (fentanyl/morphine first).
Cooperative (Level 2) or responds to commands (Level 3). Optimal sedation for most ICU patients.
→ Maintain current sedation regimen. Daily sedation breaks (SAT). Assess for delirium (CAM-ICU). Encourage early mobilisation.
Deep sedation — responds only to strong stimuli. Usually only appropriate for specific indications.
→ Acceptable for: ICP management, severe ARDS with prone positioning, refractory status epilepticus, ECMO. Otherwise: consider lightening sedation to prevent ICU delirium, prolonged ventilation, and weakness.
No response to any stimulation. Deeply sedated or possible neurological event.
→ Exclude neurological cause (CT if unexpected). Review sedation doses — likely over-sedated. Hold sedation and reassess. Check for drug accumulation (renal/hepatic failure).
Interpretation bands for the Ramsay Scale. Apply clinical judgement and local guidance.
References
- Ramsay MA, et al. Controlled sedation with alphaxalone-alphadolone. BMJ. 1974;2(5920):656–659.
Related
Curated clinical cross-links plus same-class fallbacks.
- Propofol · Anaesthetic (IV Induction / Sedation)
- Midazolam (Paediatric) · Benzodiazepine — Status Epilepticus (First-Line) / Procedural Sedation
- Midazolam (Surgical — Anxiolysis/Sedation) · Benzodiazepine — Short-Acting Sedative
- Ketamine (Anaesthesia/Sedation) · Dissociative Anaesthetic (NMDA Receptor Antagonist)
- Midazolam (IV/IM) · Benzodiazepine
- Propofol (TCI / TIVA) · Intravenous Anaesthetic Agent
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.