Table 1 Evaluation criteria for perioperative prophylactic use of proton pump inhibitors
Item | Evaluation criteria |
|---|---|
Indication | The presence of one serious risk factor from the following: 1. Mechanical ventilation > 48 h or on extracorporeal life support 2. Platelet count < 50,000/mm3 (50 × 109/L), international normalized ratio > 1.5, or partial thromboplastin time > 2.0 times the control value, or taking anticoagulant or antiplatelet drugs 3. Severe craniocerebral and cervical spinal cord injuries 4. Severe burn (adult burn area > 30%, children burn area > 15%) 5. Difficult or complex operation (operation time > 3 h) 6. Acute renal failure or renal replacement therapy or chronic liver disease or acute liver failure 7. Acute respiratory distress syndrome (ARDS) 8. Shock or persistent hypotension 9. Severe infection or sepsis 10. Cardiovascular and cerebrovascular accidents 11. Severe psychological stress The presence of at least two potential risk factors of the following: 1. Intensive care unit stay > 1 week 2. Duration of fecal occult blood > 3 days (excluding hemorrhoids) 3. Corticosteroid therapy (> 250 mg/day hydrocortisone or equivalent daily) 4. Combined use of nonsteroidal anti-inflammatory drugs (especially long-term or high-dose use) 5. Long-term fasting and parenteral nutrition |
Usage and dosage | PPIs should be administered once a day, and the single dose should not exceed the following doses (omeprazole 40 mg, lansoprazole 30 mg, esomeprazole 40 mg, pantoprazole 40 mg) |
Drug selection | Omeprazole and esomeprazole are preferred unless there is no alternative or for special reasons. For example, patients using clopidogrel should preferentially select PPIs that lack inhibition of hepatic cytochrome P450 (CYP) 2C19 enzyme, such as pantoprazole or rabeprazole |
Administration route | A standard dose of PPIs is administered intravenously or by drip Oral administration is recommended for patients who can be taken orally; intravenous administration may be considered if the patient is unable to take medications orally (including nasal feeding) or has gastrointestinal dysfunction |
Solvent | Select the appropriate solvent according to drug instructions |
Duration | When the patient is stable enough to tolerate adequate enteral nutrition or has taken food, the clinical symptoms begin to improve; the drug may be gradually withdrawn |