Stress Ulcer Prophylaxis Indication (SUP) — free guideline decision tool

Stress-ulcer prophylaxis decision aid, weighing GI-bleeding risk factors against the risks of acid suppression in the ICU.

Prophylaxis indicated with a major risk factor (mechanical ventilation > 48 h, coagulopathy) or multiple minor factors; otherwise withhold given the risk of pneumonia/C. difficile from acid suppression. Prefer PPI or H2RA.

Use to decide whether to give pharmacologic stress-ulcer prophylaxis based on the presence of major risk factors.

The strongest indications are mechanical ventilation > 48 h and coagulopathy; without these, routine prophylaxis is often unnecessary (original synthesis · not guideline verbatim). Acid suppression is not benign — it associates with nosocomial pneumonia and C. difficile, so apply it selectively. Enteral nutrition itself confers some protection and may reduce the need for pharmacologic prophylaxis.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Inputs: Mechanical ventilation > 48 hours No, Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) No, Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) No, GI ulcer/bleed in the past year No, Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) No, Sepsis No, AKI or need for renal replacement therapy No, Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) No → Result: SUP Not advised（Determination: Does not meet (no major factor and < 2 minor): clinically important bleeding risk < 4%, prophylaxis generally not needed, Management direction: No drug prophylaxis needed; start enteral nutrition early; reassess dynamically and re-evaluate if new risk factors arise, Note: Any major risk factor triggers prophylaxis: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding） Inputs: Mechanical ventilation > 48 hours Yes (major), Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) Yes (major), Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) Yes (major), GI ulcer/bleed in the past year Yes (major), Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) Yes (minor), Sepsis Yes (minor), AKI or need for renal replacement therapy Yes (minor), Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) Yes (minor) → Result: SUP Prophylaxis advised（Determination: Meets indication (major: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor: shock, sepsis, AKI/RRT, other high-risk), Management direction: Give a PPI or H2RA (low dose, oral or IV, PPI slightly preferred); start enteral nutrition early (can lower bleeding risk); stop once risk factors resolve or the patient leaves the ICU (avoid inappropriate continuation after transfer), Note: Any major risk factor triggers prophylaxis: mechanical ventilation > 48 h, coagulopathy, chronic liver disease, GI ulcer/bleed history; ≥ 2 minor factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding）