Gastrointestinal Stress Ulcer Prophylaxis

• Standardize the medication for the prophylaxis of ulcers in the ICU
• Limit the use to critically ill patients with moderate-high individual risk factors

• Both proton pump inhibitors (PPI) and H2 receptor antagonists (H2RA) reduce the risk of clinically important bleeding compared to no prophylaxis
• Treatment options
  • Regimen
    • Start IV Pantoprazole when criteria met
      • Famotidine for major burns
    • Switch to PO Famotidine when appropriate for PO meds
  • Doses
    • Pantoprazole 40mg IV/PO daily
    • Famotidine 20 mg IV/PO BID
      • Famotidine 20mg IV/PO QD for CrCl less than 50
  • If confirmed and/or suspected upper gastrointestinal bleeding
    • Pantoprazole IV BID
  • If a patient was receiving a PPI at home, continue this class of medication

Any patient with ≥1 high-risk factors or ≥2 moderate-risk factors

• Patients with TBI, SCI, major burn and recent history of gastric or duodenal ulceration/bleeding or GD/GJ anastomosis should remain on stress ulcer prophylaxis while in the ICU
• All other patients can discontinue prophylaxis when they are tolerating enteral feeds and have less than 2 risk factors

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