What are the primary indications for stress ulcer prophylaxis in ICU?

Mechanical ventilation >48h and coagulopathy (INR >1.5, PLT 35% TBSA, traumatic brain injury, and recent GI bleeding are secondary indications.

Is PPI or H2RA preferred for stress ulcer prophylaxis?

PPIs more effectively prevent clinically significant GI bleeding but increased risk of C. difficile infection and VAP compared to H2RA; 2018 SUP-ICU trial showed no significant mortality difference between PPI and H2RA.

When should stress ulcer prophylaxis be discontinued?

When primary risk factors resolve: patient extubated for >24h, coagulopathy resolved, tolerating enteral nutrition (EN reduces GI bleeding risk); continued PPI after ICU discharge for GI prophylaxis is not supported.

Does enteral nutrition reduce the need for pharmacological SUP?

PEPTIC trial included patients on EN; EN provides mucosal cytoprotection; some guidelines suggest EN alone may be adequate prophylaxis in low-risk patients without mechanical ventilation or coagulopathy.

What C. difficile risk does PPI use create in ICU?

PPI use increases C. difficile risk 1.5-2.5x by altering gastric pH and intestinal flora; IV to oral switch as soon as possible; avoid PPIs in low-risk ICU patients without clear indication; antimicrobial stewardship applies to acid-suppressive therapy too.

Stress Ulcer Prophylaxis Risk Stratification in ICU Patients

Stratifies ICU stress ulcer prophylaxis risk using Targownik criteria (mechanical ventilation >48h, coagulopathy) and modified ASHP risk factors to guide PPI vs H2RA selection and de-escalation timing.

Weight

Height

Clinical Guidance

BMI is a screening measure of body size, not a direct measure of body fat. The standard WHO categories are underweight (<18.5), normal (18.5–24.9), overweight (25–29.9), and obese (≥30).

BMI can overestimate body fat in athletes with high muscle mass and underestimate it in older adults with low muscle mass. Interpret it alongside waist circumference and clinical context rather than as a standalone diagnosis.

⚕ Clinical Disclaimer: These calculators are for educational and reference purposes only. Always verify results with qualified clinical judgment and current clinical guidelines. Do not use as a sole basis for medical decisions.

How It Works

Each component has a specific meaning:

Targownik criteria (mechanical ventilation >48h — The targownik criteria (mechanical ventilation >48h recorded for the patient or scenario being assessed.
Coagulopathy) — The coagulopathy) recorded for the patient or scenario being assessed.
Modified ASHP risk factors — The modified ashp risk factors recorded for the patient or scenario being assessed.

Note: Interpret the stress ulcer sup risk result against the clinical thresholds and context described above.

How to Use

Enter the Targownik criteria (mechanical ventilation >48h, coagulopathy), modified ASHP risk factors for the patient or scenario you are assessing. Stratifies ICU stress ulcer prophylaxis risk using Targownik criteria (mechanical ventilation >48h, coagulopathy) and modified ASHP risk factors to guide PPI vs H2RA selection and de-escalation timing. Use the stress ulcer sup risk result to inform your clinical assessment.

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