SSC 2012 Guidelines Stress Ulcer Prophylaxis (SUP)

R. Jaeschke

Copyright 2014 SCCM/ESICM

Stress Ulcer Prophylaxis• We recommend that stress ulcer

prophylaxis using H2 blocker or proton pump inhibitor be given to patients with severe sepsis/septic shock who have bleeding risk factors (Grade 1B).

• We suggest that patients without risk factors should not receive prophylaxis (Grade 2B).

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Cook et al. N Engl J Med. 1994;330:377-381

3.7% of patients with one or both risk factors bled, <0.2% of patients without either of them bled.

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How Frequent Is Clinically Important Bleeding? Can We Prevent It with H2RA?

Marik et al. Crit Care Med. 2010;38:2222-2228

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Dellinger et al. Crit Care Med. 2013;41:580–637Dellinger et al. Intensive Care Med. 2013;39:165-228

Stress Ulcer Prophylaxis• When stress ulcer prophylaxis is used, we

suggest the use of proton pump inhibitors rather than H2 receptor antagonists (Grade 2C).

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Do We Have Options Other Than H2RA?

Alhazzani et al. Crit Care Med. 2013;41:693-705

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Dellinger et al. Crit Care Med. 2013;41:580–637Dellinger et al. Intensive Care Med. 2013;39:165-228

• We recommend that stress ulcer prophylaxis using H2RA or PPI be given to patients with severe sepsis/septic shock who have bleeding risk factors (Grade 1B).

• When SUP is used, we suggest the use of PPI rather than H2RA (Grade 2C).

• We suggest that patients without risk factors should not receive prophylaxis (Grade 2B).

Slide 9Copyright 2014 SCCM/ESICM