Stress Ulcer Prophylaxis

Level 1

i.     There is no difference between H2 antagonists, cytoprotective agents, and some proton pump inhibitors

ii.     Antacids should not be used as stress ulcer prophylaxis.

Level 2

i.     Aluminum containing compounds should not be used in patients on dialysis

Level 3

i.     Enteral feeding alone may be insufficient stress ulcer prophylaxis

Level 1

i. Prophylaxis is recommended for all patients with:

1. Mechanical ventilation
2. Coagulopathy
3. Traumatic brain injury 
4. Major burn injury

Level 2

i. Prophylaxis is recommended for all ICU patients with:

1. Multi-trauma
2. Sepsis
3. Acute renal failure

Level 3

i.     Prophylaxis is recommended for all ICU patients with:

1. ISS>15
2. Requirement of high-dose steroids (>250 mg hydrocortisone or equivalent per day)

ii.     In selected populations, no prophylaxis is necessary

Level 1

i. There were no level 1 recommendations

Level 2

i. During mechanical ventilation or intensive care unit stay

Level 3

i. Until able to tolerate enteral nutrition