The levels of recommendation (1-3) and the classes of evidence (I–III) are defined at the end of the "Major Recommendations" field.
What are the risk factors for stress ulcer development and which patients require prophylaxis?
- Level 1 recommendations
- Prophylaxis is recommended for all patients with:
- Mechanical ventilation
- Coagulopathy
- Traumatic brain injury
- Major burn injury
- Level 2 recommendations
- Prophylaxis is recommended for all Intensive Care Unit (ICU) patients with:
- Multi-trauma
- Sepsis
- Acute renal failure
- Level 3 recommendations
- Prophylaxis is recommended for all ICU patients with:
- Injury Severity Score (ISS) >15
- Requirement of high-dose steroids (>250 mg hydrocortisone or equivalent per day)
- In selected populations, no prophylaxis is necessary
Is there a preferred agent for stress ulcer prophylaxis? If so, which?
- Level 1 recommendations
- There is no difference between H2 antagonists, cytoprotective agents, and some proton pump inhibitors
- Antacids should not be used as stress ulcer prophylaxis.
- Level 2 recommendations
- Aluminum containing compounds should not be used in patients on dialysis
- Level 3 recommendations
- Enteral feeding alone may be insufficient stress ulcer prophylaxis
What is the duration of prophylaxis?
- Level 1 recommendations
- There were no level 1 recommendations
- Level 2 recommendations
- During mechanical ventilation or intensive care unit stay
- Level 3 recommendations
- Until able to tolerate enteral nutrition
Definitions:
Classes of Evidence
Class I: A prospective randomized clinical trial.
Class II: A prospective non-comparative clinical study or a retrospective analysis based on reliable data.
Class III: A retrospective case series or database review.
Levels of Recommendation
Level 1: The recommendation is convincingly justifiable based on the available scientific information alone. This recommendation is usually based on Class I data, however, strong Class II evidence may form the basis for a level 1 recommendation, especially if the issue does not lend itself to testing in a randomized format. Conversely, low quality or contradictory Class I data may not be able to support a level 1 recommendation.
Level 2: The recommendation is reasonably justifiable by available scientific evidence and strongly supported by expert opinion. This recommendation is usually supported by Class II data or a preponderance of Class III evidence.
Level 3: The recommendation is supported by available data but adequate scientific evidence is lacking. This recommendation is generally supported by Class III data. This type of recommendation is useful for educational purposes and in guiding future clinical research.