💊 Stress Ulcer Prophylaxis Indication (SUP)
Use[Pending update] Some thresholds, grades and management recommendations on this page that conflict with curre…
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SourceASHP therapeutic guidelines on stress-ulcer prophylaxis.
Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders
This-shift next steps
After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.
Scene next step
📋icu scoresOpen scene pack →Score + version; reference only — not a substitute for care · no HIS write
Paste the link in Slack, Teams, X, or LinkedIn — the preview image comes from this page’s Open Graph card.
Methodology · worked example, guidelines & full notes
Clinical takeaway
The strongest indications are mechanical ventilation [pending update] and coagulopathy; without these, routine prophylaxis is often unnecessary (original synthesis · not guideline verbatim).
When to use
[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.
How it works
otherwise withhold given the risk of pneumonia/C. difficile from acid suppression. Prefer PPI or H2RA.
Key points
- 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.
References
- [Guideline / primary source]ASHP therapeutic guidelines on stress-ulcer prophylaxis.
- Krag M, et al. SUP-ICU trial. N Engl J Med 2018.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| 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 |
→SUPNot 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
| 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 |
→SUPProphylaxis 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
Verification & sources · governance
FAQ
Frequently asked questions
- What are the limits and cautions when using Stress Ulcer Prophylaxis Indication (SUP)?
- 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.
- Does Stress Ulcer Prophylaxis Indication (SUP) upload patient data? Where is it calculated?
- 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.
- How is Stress Ulcer Prophylaxis Indication (SUP) calculated in practice? Can you show a worked example?
- 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）