Recommendations for Stress Ulcer Prophylaxis in Critically Ill Adults: A Contextualized Clinical Practice Guideline From the Saudi Critical Care Society and the Scandinavian Society of Anaesthesiology and Intensive Care Medicine, Endorsed by the Kuwait Anesthesia and Critical Care Society
Abstract
Background: Critically ill adults are at risk for stress-related upper gastrointestinal bleeding (UGIB). Regional variations in gastrointestinal bleeding incidence, infection epidemiology, formulary access, and the relative value placed on bleeding versus infection outcomes by patients and clinicians necessitate contextualized recommendations. This guideline provides regionally adapted, evidence-based recommendations for the use of stress ulcer prophylaxis (SUP) in Saudi Arabia, Kuwait, and the Nordic countries using the GRADE-ADOLOPMENT methodology.
Methods: A multidisciplinary panel from both regions prioritized PICO questions and ranked outcomes by patient importance. The 2024 Society of Critical Care Medicine (SCCM) and American Society of Health-System Pharmacists (ASHP) guideline served as the source guideline and was evaluated for credibility; contextual fit in Saudi Arabia, Kuwait, and the Nordic countries; and alignment with the GRADE methodology. Evidence profiles and Evidence-to-Decision frameworks were adapted or developed, incorporating updated data, local epidemiology, drug access, and health system variables such as equity, cost, and feasibility.
Results: The panel adopted the following five recommendations. In critically ill adults with coagulopathy, shock, or chronic liver disease, the panel suggests using SUP over no SUP (conditional recommendation; moderate certainty). In enterally fed patients at high risk of UGIB, the panel suggests using SUP over no SUP…
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