| 7 Dangerous agitation | Pulling at endotracheal tube, trying to remove catheters, climbing over bedrail, striking at staff, thrashing side to side | +4 Combative | Overtly combative, violent, immediate danger to staff |
| 6 Very agitated | Requiring restraint and frequent verbal reminding of limits, biting endotracheal tube | +3 Very agitated | Pulls or removes tube(s) or catheter(s); aggressive |
| 5 Agitated | Anxious or physically agitated, calms to verbal instructions | +2 Agitated | Frequent nonpurposeful movement, fights ventilator |
| 4 Calm and cooperative | Calm, easily arousable, follows commands | +1 Restless | Anxious but movements not aggressive vigorous |
| 3 Sedated | Difficult to arouse but awakens to verbal stimuli or gentle shaking, follows simple commands but drifts off again | 0 Alert and calm | - |
| 2 Very sedated | Arouses to physical stimuli but does not communicate or follow commands, may move spontaneously | -1 Drowsy | Not fully alert, but has sustained awakening (eye opening/eye contact) to voice (≥ 10 s) |
| 1 Unarousable | Minimal or no response to noxious stimuli, does not communicate or follow commands | -2 Light sedation | Briefly awakens with eye contact to voice (< 10 s) |
| -3 Moderate sedation | Movement or eye opening to voice (but no eye contact) |
| -4 Deep sedation | No response to voice, but movement or eye opening to physical stimulation |
| -5 Unarousable | No response to voice or physical stimulation |