💊 Stress Ulcer Prophylaxis Indication (SUP)
Stress-ulcer prophylaxis decision aid, weighing GI-bleeding risk factors against the risks of acid suppression in the ICU.
Stress Ulcer Prophylaxis Indication (SUP)
Mechanical ventilation > 48 hours
Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal)
Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed)
GI ulcer/bleed in the past year
Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4)
Sepsis
AKI or need for renal replacement therapy
Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids)
When to use
Use to decide whether to give pharmacologic stress-ulcer prophylaxis based on the presence of major risk factors.
How it works
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.
Key points
- 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.
References
- ASHP therapeutic guidelines on stress-ulcer prophylaxis.
- Krag M, et al. SUP-ICU trial. N Engl J Med 2018.
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.