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 Two methods have been well validated for monitoring sedation levels with equivalent results:The Richmond Agitation‐Sedation Scale (Table 2.1) extends from –5 (unarousable) to +4 (combative) with zero representing a calm and alert patient. A typical goal is a light sedation of –1 to –2.The Riker Sedation‐Agitation Scale (Table 2.2), extends from 1 (unarousable) to 7 (dangerous agitation), with 4 representing the calm and alert patient. A typical goal is a light sedation of 3.

 Objective monitoring modalities such as EEG, bispectral index, or patient state index are not recommended by the Society of Critical Care Medicine guidelines as a regular monitoring tool. However, if the patient is paralyzed (through neuromuscular blockers or clinical condition), then use of an objective monitoring device is suggested.

Table 2.1 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 has aggressive behaviour toward staff
2	Agitated	Frequent non‐purposeful movement or patient–ventilator dyssynchrony
1	Restless	Anxious or apprehensive but movements not aggressive or vigorous
0	Alert and calm
–1	Drowsy	Not fully alert, but has sustained (more than 10 seconds) awakening, with eye contact, to voice
–2	Light sedation	Briefly (less than 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

Table 2.2 Riker Sedation‐Agitation Scale.

Score	Term	Description
7	Dangerous agitation	Pulling at endotracheal tube, trying to remove catheters, striking staff
6	Very agitated	Does not calm down despite verbal instructions, requires physical restraints
5	Agitated	Anxious or mildly agitated, calms with verbal instructions
4	Calm and cooperative	Arouses easily and follows commands
3	Sedated	Does arouse to verbal or physical stimulus, able to follow simple commands
2	Very sedated	Does not follow commands but arouses to physical stimulation
1	Unarousable	Little or no response to noxious stimuli