Stress ulcer prophylaxis in the Intensive Care Unit: an integrative review




Stress ulcer prophylaxis; Intensive therapy; Intensive Care.


Stress ulcers (SU) are a common complication in patients admitted to intensive care units (ICU), which are defined as upper gastrointestinal tract ulcers, and some forms can evolve to hemorrhage. Given the hemodynamic consequences caused in patients with SU in the context of the intensive care unit, this article aims to investigate pathophysiological causes, prophylaxis and therapies to avoid bleeding risks. This is a bibliographical and exploratory review study using the integrative literature review method, carried out in the PUBMED, EMBASE and LILACS databases, using the descriptors/key words: "Stress Ulcer" AND "Intensive Care Unit". Initially, the search returned 1,074 works, after applying the inclusion and exclusion criteria, seven were selected for this study. It was observed that patients on mechanical ventilation for more than 48 hours, coagulopathy, shock, renal failure with hemodialysis, history of peptic ulcer, previous upper digestive hemorrhage, multiple trauma, septic and liver failure, have an increased risk of 3600% for developing EU. Prophylaxis should be carried out individually and following specific recommendations for the local population, to avoid errors, misuse of antibiotics and inadequate prior withdrawal. It is noteworthy that there are few randomized studies that assess the therapeutic efficacy of SU prophylaxis in Brazil, requiring further studies for evaluation directed at the Brazilian population.


Barbateskovic, M., Marker, S., Granholm, A., Anthon, C. T., Krag, M., Jakobsen, J. C., ... & Møller, M. H. (2019). Stress ulcer prophylaxis with proton pump inhibitors or histamin-2 receptor antagonists in adult intensive care patients: a systematic review with meta-analysis and trial sequential analysis. Intensive care medicine, 45(2), 143-158.

Blackett, J. W., Faye, A. S., Phipps, M., Li, J., Lebwohl, B., & Freedberg, D. E. (2020, December). Prevalence and Risk Factors for Inappropriate Continuation of Proton Pump Inhibitors After Discharge From the Intensive Care Unit. In Mayo Clinic Proceedings. Elsevier.

Dargent, A., Jacquier, M., Rozencwajg, S., Andreu, P., & Quenot, J. P. (2020). Stress ulcer prophylaxis in ICU patients: Answers and questions from the PEPTIC trial.

Franchitti, M., Piubellini, J., Sadeghipour, F., Eckert, P., Voirol, P., & Schneider, A. G. (2020). Adequacy of stress ulcer prophylaxis prescription in the intensive care unit: an observational study. Swiss Medical Weekly, 150(3536).

Gupta, D., Bhalotra, A. R., & Singh, R. (2020). Audit on practices of stress ulcer prophylaxis in intensive care unit patients. Indian Journal of Critical Care Medicine: Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine, 24(3), 160.

Koche, J.C. (2011). Fundamentos de metodologia científica: teoria da ciência e iniciação à pesquisa. 1 ed. Petrópolis, RJ: Vozes

Klompas, M. (2019, August). Prevention of intensive care unit-acquired pneumonia. In Seminars in respiratory and critical care medicine (Vol. 40, No. 04, pp. 548-557). Thieme Medical Publishers.

Krag, M., Perner, A., Wetterslev, J., Lange, T., Wise, M. P., Borthwick, M., ... & Møller, M. H. (2017). Stress ulcer prophylaxis in the intensive care unit trial: detailed statistical analysis plan. Acta Anaesthesiologica Scandinavica, 61(7), 859-868.

Krag, M., Marker, S., Perner, A., Wetterslev, J., Wise, M. P., Schefold, J. C., ... & Møller, M. H. (2018). Pantoprazole in patients at risk for gastrointestinal bleeding in the ICU. New England Journal of Medicine, 379(23), 2199-2208.

Marker, S., Krag, M., Perner, A., Wetterslev, J., Lange, T., Wise, M. P., ... & SUP-ICU trial investigators. (2019). Pantoprazole in ICU patients at risk for gastrointestinal bleeding—1 year mortality in the SUP - ICU trial. Acta Anaesthesiologica Scandinavica, 63(9), 1184-1190.

Marker, S., Perner, A., Wetterslev, J., Barbateskovic, M., Jakobsen, J. C., Krag, M., ... & Møller, M. H. (2017). Stress ulcer prophylaxis versus placebo or no prophylaxis in adult hospitalised acutely ill patients—protocol for a systematic review with meta-analysis and trial sequential analysis. Systematic reviews, 6(1), 1-8.

Mendes, J. J., Silva, M. J., Miguel, L. S., Gonçalves, M. A., Oliveira, M. J., Oliveira, C. D. L., & Gouveia, J. (2019). Sociedade Portuguesa de Cuidados Intensivos guidelines for stress ulcer prophylaxis in the intensive care unit. Revista Brasileira de terapia intensiva, 31(1), 5-14.

Morgan, D. J., Dhruva, S. S., Coon, E. R., Wright, S. M., & Korenstein, D. (2019). 2019 update on medical overuse: a review. JAMA internal medicine, 179(11), 1568-1574.

Muzlovič, I., & Štubljar, D. (2019). Stress ulcer prophylaxis as a risk factor for tracheal colonization and hospital-acquired pneumonia in intensive care patients: impact on latency time for pneumonia. Acta Clinica Croatica, 58(1), 72.

Pereira, A. S., Shitsuka, D.M., Parreira,F. J.,& Shitsuka, R.(2018).Metodologia da pesquisa científica.[e-book]. Santa Maria. Ed (pp. 3-9). UAB/NTE/UFSM. https://repositorio. ufsm. br/bitstream/handle/1/15824/Lic_Computacao_Metodologia-Pesquisa -Cientifica. pdf.

Reynolds, P. M., & MacLaren, R. (2019). Reevaluating the Utility of Stress Ulcer Prophylaxis in the Critically Ill Patient: A Clinical ScenarioBased MetaAnalysis. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, 39(3), 408-420.

Santos, Y. D. A. P. D., Younes-Ibrahim, M. S., Crozatti, L. L., Raglione, D., Cardozo, L. C. M., Besen, B. A. M. P., ... & Mendes, P. V. (2020). Adesão a um protocolo de profilaxia de úlcera de estresse em pacientes críticos: estudo de coorte prospectiva. Revista Brasileira de Terapia Intensiva, 32, 37-42.

Schefold, J. C., Krag, M., Marker, S., Perner, A., Wetterslev, J., Wise, M. P., ... & Møller, M. H. (2019). Outcomes of prophylactic pantoprazole in adult intensive care unit patients receiving dialysis: results of a randomized trial. American journal of nephrology, 50(4), 312-319.

Sun, J., Wang, B., Cao, P., Zhu, H., Lu, K., Geng, P., & Tan, D. (2019). Benefits and risks of stress ulcer prevention with proton pump inhibitors for critical patients: an observational cohort study with 1 972 patients. Zhonghua wei zhong bing ji jiu yi xue, 31(5), 539-544.

Young, P. J., Bagshaw, S. M., Forbes, A. B., Nichol, A. D., Wright, S. E., Bailey, M., ... & Rowan, K. M. (2020). Effect of stress ulcer prophylaxis with proton pump inhibitors vs histamine-2 receptor blockers on in-hospital mortality among ICU patients receiving invasive mechanical ventilation: the PEPTIC randomized clinical trial. Jama, 323(7), 616-620.



How to Cite

SILVA, R. F. da; SANTOS, S. L. dos; AFONSO, T. de O.; SILVA, F. P. da; RIBEIRO, S. de S. C.; GAMA, S. M. B. da C. .; FONSECA, S. da S. S. .; LEITE, A. C.; SOUSA, M. da C. V. .; BARBOSA, M. F. L. .; PESSÔA, F. G. de S.; BARROS, G. M. de .; CARVALHO, F. R. de .; SILVA, A. B. da; OLIVEIRA, W. K. S. .; SILVA, R. S. C. .; MACIEL, A. C. . Stress ulcer prophylaxis in the Intensive Care Unit: an integrative review. Research, Society and Development, [S. l.], v. 10, n. 10, p. e500101019001, 2021. DOI: 10.33448/rsd-v10i10.19001. Disponível em: Acesso em: 3 mar. 2024.



Health Sciences