Ucsd medical center

FILE: Trauma Handbook/ stress ulcer prophylaxis
UCSD MEDICAL CENTER
ADULT AND PEDIATRIC GUIDELINES FOR USE OF
STRESS ULCER PROPHYLAXIS*
*Developed by the Stress Ulcer Prophylaxis Process Action Team Based on clinical studies, the indications for stress ulcer prophylaxis will be graded according to the following scale: Convincing evidence, indicated
Some evidence, probably indicated
No evidence, indication uncertain
Not recommended, not indicated

The following criteria have an “A” rating:
1. ICU patients:
• With coagulopathy • On corticosteroids • Major infectious complications • Acute trauma spinal cord injury with neurologic deficit 3. Neonates NPO plus multiple doses of dexamethasone
4. Major burn injury >35% TBSA
The following criteria have a “B” rating:
1. ICU patients:
• On anticoagulation • With multiple organ failure • With prolonged NPO status (> 5 days) with GI pathology or after major surgery • With acute renal failure • On anticoagulation with comorbid disease, age >60, history of UGIB, on 3. Liver transplant patients NPO on immunosuppression 4. Patients on any dosage of corticosteroids with predisposing conditions for PUD or on NSAIDs or on high doses of corticosteroids (>1 G prednisone)
The following criteria have a “C” rating:
1. Inpatients:
• NPO • With coagulopathy (elevated PT/PTT) 2. Neonates NPO plus multiple organ failure, liver or renal failure or coagulopathy
The following criteria have a “D” rating
1. These conditions are not independent indications for stress ulcer prophylaxis:
• Bacteremia without sepsis • Advanced age (>60) • Total corticosteroids dosage (< 1 g prednisone)
Comments:
1. Judicious use of stress ulcer prophylaxis may be responsible for decreased incidence of
stress ulceration; decreased adverse drug reaction, drug interactions, and unnecessary expense. 2. In most patients that meet criteria for stress ulcer prophylaxis, full oral or intra-gastric enteral nutrition serves as adequate protection. However, some patients remain at high risk for ulcer-related bleeding despite routine enteral feeding. Theses include, but are not limited to patients in category A 1-3. In these high risk patients, enteral feeding may not provide adequate prophylaxis and additional pharmocological agents are indicated. 3. Intra-gastric feeds with high residuals may indicate GI pathology, therefore, neither oral pharmacotherapy or enteral feeds should be considered adequate protection. 4. In a patient who tolerates liquids for greater than 24 hours, the intravenous medication 5. There is no data supporting the use of concomitant sucralfate and an H2-antagonist. Stress ulcer prophylaxis drugs of choice. • Studies have shown equal prophylactic efficacy between H2-antagonists, antacids and • There is also data available that intra-gastric feeds serve as adequate stress ulcer COST/DAY
Famotidine 40 mg/day continuous infusion

Source: http://surgery.ucsd.edu/specialties/trauma-burn/training/protocols/Documents/Stress_Ulcer_Prophylaxis.pdf