Which score on the RASS indicates a patient is completely unresponsive?

A score of -4 on the Richmond Agitation-Sedation Scale (RASS) indicates that a patient is completely unresponsive. This score reflects the most profound level of sedation, where the patient does not exhibit any response to stimuli, including verbal commands or physical touch. In this state, the individual is unable to engage or demonstrate any level of awareness of their surroundings.

In comparison, a score of -2 suggests a patient who is still somewhat arousable with physical stimulation but may not respond verbally or have a clear interaction, reflecting a reduced state of consciousness rather than a complete lack of responsiveness. A score of 0 indicates the patient is alert and calm, actively engaging with their environment. A score of +4 represents extreme agitation, where the patient is overtly combative and unable to cooperate, which is the opposite end of the responsiveness spectrum. Therefore, the distinct characteristics of a -4 score make it clear that it indicates a state of total unresponsiveness.