Patients on mechanical ventilation, with ARDS, AKI, septic shock, coagulopathy, high dose steroids, or critically ill with high PRISM score should probably be placed on stress ulcer prophylaxis, using H2 receptor antagonists or PPIs.

Some practitioners prefer H2 blockers as first line.

we recommend PPIs, due to the side effects of H2 blockers.

• Prospective studies have demonstrated similar rates of GI hemorrhage in adults and children in ICU (up to 10%) (Chaibou, Pediatrics 1998)
• Risk factors include respiratory failure, coagulopathy PRISM >10, circulatory shock, multi organ failure, trauma, or recent surgery.
• Others have demonstrated mechanical ventilation as a risk factor.
• H2 receptor antagonists
  • Potential adverse events include: thrombocytopenia, drug interactions, and CNS impairment in the presence of renal injury.
• PPIs
  • Potential adverse events include larger association with ventilator associated pneumonia and C difficile. high cost is also a factor.