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Stress ulcer prophylaxis may now be unnecessary in the modern PICU environment. Based on the facts that the overall rate of significant gastrointestinal bleeding (sGIB) in PICU is low, and that the evidence that SUP prevents sGIB in children is poor, that most sGIBs occur in children with Zinner score > 3, and that nosocomial infection rates may be worsened by SUP, we recommend the use of SUP on children who are NPO and likely to be intubated for > 48 hrs and who have 2 or more other organ failures. Alternatively, not using stress ulcer prophylaxis routinely at all is reasonable.
Most Recent References
Stress Ulcer Prophylaxis Versus Placebo-A Blinded Pilot Randomized Controlled Trial to Evaluate the Safety of Two Strategies in Critically Ill Infants With Congenital Heart Disease (SUPPRESS-CHD). Mills KI, Albert BD, Bechard LJ, Chu S, Duggan CP, Kaza A, Rakoff-Nahoum S, Sleeper LA, Newburger JW, Priebe GP, Mehta NM. Pediatr Crit Care Med. 2024 Feb 1;25(2):118-127.
Associations between enteral nutrition and outcomes in the SUP-ICU trial: Protocol for exploratory post hoc analyses. Borthwick M, Granholm A, Marker S, Krag M, Lange T, Wise MP, Bendel S, Keus F, Guttormsen AB, Schefold JC, Wetterslev J, Perner A, Møller MH; SUP-ICU investigators. Acta Anaesthesiol Scand. 2023 Apr;67(4):481-486.
Associated Mortality Risk of Proton Pump Inhibitor Therapy for the Prevention of Stress Ulceration in Intensive Care Unit Patients: A Systematic Review and Meta-analysis. Reynolds PM, Wells L, Powell M, MacLaren R. J Clin Gastroenterol. 2023 Jul 1;57(6):586-594.