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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Copyright 2014 SCCM/ESICM

3.7% of patients with one or both risk factors bled, <0.2% of

patients without either of them bled.
Cook et al. N Engl J Med. 1994;330:377-381
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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;41:580637

Dellinger et al. Intensive Care Med. 2013;39:165-228
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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

Slide 7
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Dellinger et al. Crit Care Med. 2013;41:580637

Dellinger et al. Intensive Care Med. 2013;39:165-228
Slide 8
Copyright 2014 SCCM/ESICM

 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 9
Copyright 2014 SCCM/ESICM