Sedation

A sedation score is a structured measure of arousability and agitation at a particular moment. It is not a diagnosis and does not, by itself, explain why the patient is difficult to wake or unusually restless. Sedative medication can suppress brain arousal in a dose-dependent manner, but critical illness can produce a similar bedside picture. Hypoxaemia, hypercapnia, hypoglycaemia, shock, seizures, stroke, pain, withdrawal, and delirium may all change the patient’s response. The nurse therefore interprets the score alongside the medication record, respiratory status, haemodynamics, and neurological findings. The purpose is not to make the patient as unresponsive as possible. For most mechanically ventilated adults, the desired state is light sedation: calm or briefly rousable, able to interact when clinically appropriate, and not so deeply sedated that ventilator liberation is delayed. A usual target is RASS –2 to 0. A target of –2 to +2 may be reasonable when specifically justified by the patient’s condition and documented in the plan. Validated scoring makes the target visible to the whole team. It also reveals drift: a patient whose score changes from –1...