Stress Ulcer Prophylaxis Indication (SUP) — free guideline decision tool

Stress-ulcer prophylaxis decision aid, weighing GI-bleeding risk factors against the risks of acid suppression in the ICU.

otherwise withhold given the risk of pneumonia/C. difficile from acid suppression. Prefer PPI or H2RA.

[Pending update] Some thresholds, grades and management recommendations on this page that conflict with current guidelines or are unverified are temporarily hidden pending verification against the guideline text.

The strongest indications are mechanical ventilation [pending update] 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.

For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.

Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.

Inputs: Mechanical ventilation (duration threshold pending update) No, Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) No, Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) No, GI ulcer/bleed in the past year No, Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) No, Sepsis No, AKI or need for renal replacement therapy No, Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) No → Result: SUP Not advised（Determination: Does not meet (no major factor; minor-factor rule [pending update]): clinically important bleeding risk [pending update], prophylaxis generally not needed, Management direction: No drug prophylaxis needed; start enteral nutrition early; reassess dynamically and re-evaluate if new risk factors arise, Note: factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding） Inputs: Mechanical ventilation (duration threshold pending update) Yes, Coagulopathy (platelets < 50 / INR > 1.5 / PTT > 2× normal) Yes, Chronic liver disease (cirrhosis/portal hypertension/history of variceal bleed) Yes, GI ulcer/bleed in the past year Yes, Shock (vasopressors / SBP < 90 / MAP < 70 / lactate > 4) Yes, Sepsis Yes, AKI or need for renal replacement therapy Yes, Other high-risk (TBI/SCI/polytrauma ISS > 16/burn > 35%/high-dose steroids) Yes → Result: SUP Prophylaxis advised（Determination: Meets indication (major: mechanical ventilation [pending update], coagulopathy, chronic liver disease, GI ulcer/bleed history; :shock, sepsis, AKI/RRT, other high-risk), Management direction: Give a PPI or H2RA (low dose, oral or IV); start enteral nutrition early (can lower bleeding risk); stop once risk factors resolve or the patient leaves the ICU (avoid inappropriate continuation after transfer), Note: factors trigger prophylaxis: shock, sepsis, AKI/RRT, TBI/SCI/polytrauma/burn/high-dose steroids, etc. The 2024 SCCM/ASHP guidance emphasizes coagulopathy, shock and chronic liver disease as major risks; enteral nutrition lowers bleeding）