Indications for stress ulcer prophylaxis in critically ill patients
| Major risk factors (prophylaxis recommended) |
| Positive pressure ventilation > 48 hours, including extracorporeal life support Coagulopathy (platelet count < 50 × 109/L, international normalized ratio > 1.5, activated partial thromboplastin time > 2 times normal)a History of gastrointestinal ulceration or bleeding within past year Acute traumatic brain or spinal cord injury Major thermal injury (≥ 35% of total body surface area) |
| Minor risk factors (prophylaxis recommended if ≥ 2 minor criteria are present) |
| Sepsis Intensive care unit stay > 1 week Occult gastrointestinal bleeding for ≥ 6 days Glucocorticoid therapy (> 250 mg of hydrocortisone or the equivalent) Use of antiplatelet or nonsteroidal anti-inflammatory agents Renal failure or renal replacement therapy Hepatic failure History of peptic ulcer disease Extracorporeal life support Organ transplantation |
a Independent predictors of clinically important gastrointestinal bleeding in critically ill patients.
Based on information in references 3, 5, 6, 8, and 12.