Restaurants, culture…and a sedation scale. Richmond shines thanks to a VCU intensive care doctor.

In recent years Richmond has been put on the map for its food scene, arts and outdoor events, and quality of life.

VCU’s Curt Sessler, M.D. gave Richmond another accolade, albeit one known more to clinicians and researchers: perhaps the most widely used ICU sedation scale in the world.

The Richmond Agitation-Sedation Scale (RASS) was created two decades ago out of a challenge, Sessler says, to better understand the comfort level of patients in the ICU.

“Our intent was to make the scale accurate and reliable, and something that was also simple to use and recall easily,” he says. Sessler assembled a multidisciplinary team of professionals responsible for ICU patients — nurses, pharmacists, physicians — and created the RASS. Scale in hand, they submitted it for peer review, which validated its effectiveness in 2002.

Today, the RASS is used in hospitalized patients to describe their level of alertness or agitation. The scale scores guide sedation therapy and titration and improve communication among providers. The scale is mostly referenced for mechanically ventilated patients in order to avoid over- or under-sedating them. Excessive sedation, for example, can delay a patient’s recovery, while under-sedation may leave a person in discomfort.

 Ten years after it was developed, Sessler worked with Innovation Gateway to copyright the RASS. The protection allows the scale’s use free of charge for health systems, clinicians, and researchers (it’s easily Google-able). Meanwhile, pharmaceutical companies must license the scale, a proven reliable tool, in clinical trials that are comparing sedative medications.

 “We want to have the RASS as widely used as possible, without any barriers to use in the clinical setting, and I give my complete support and approval for its use in research,” Sessler says. “I didn’t really envision a revenue stream for VCU out of it, but I think it’s appropriate to charge pharmaceutical companies that rely on it for their clinical trials, similar to use of validated instruments.”

 For Sessler, it’s about improving patient care and creating more effective medications. “I’ve really just enjoyed hearing from people around the country and around the world with their interest in RASS, and their clever ideas to incorporate it into their research and patient care,” Sessler says. “It’s rewarding.”


PHOTO CAPTION: Curtis N. Sessler, M.D., the Orhan Muren Distinguished Professor of Medicine in the Department of Internal Medicine, led a team that created the most widely used agitation and sedation scale. Key collaborators on his research from VCU was Mary Jo Grap, RN, Ph.D., now retired from the School of Nursing, and Gretchen M. Brophy, Pharm. D. from the School of Pharmacy.