{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:59:26Z","timestamp":1785135566041,"version":"3.55.0"},"reference-count":20,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Background: Acute upper gastrointestinal bleeding (UGIB) remains a leading cause of emergency department (ED) admission and carries a mortality of 5\u201310%. Static hemodynamic parameters perform poorly as predictors of fluid responsiveness, exposing patients either to under-resuscitation or to the harms of fluid overload. The mini fluid challenge (MFC), in which a 100 mL bolus is used to elicit a measurable change in the left ventricular outflow tract velocity\u2013time integral (\u0394VTI), is a validated dynamic test in intensive care but has not been evaluated in undifferentiated ED haemorrhagic shock. We aimed to determine whether \u0394VTI-guided resuscitation is feasible at the bedside in UGIB and to explore how \u0394VTI relates to in-hospital mortality. Methods: Prospective, single-centre, randomised quasi-experimental comparative study conducted between February 2024 and February 2025. Adults presenting with UGIB were allocated by treatment period, and credentialed emergency physicians to an ultrasound-guided protocol group (UGPG) or a standard care protocol group (SCPG). \u0394VTI was measured in both groups but was disclosed to the treating team only in UGPG; in SCPG, it was recorded offline and analysed post hoc. The primary outcome was the feasibility of \u0394VTI acquisition; the association of \u0394VTI with in-hospital mortality was a secondary, exploratory outcome. Results: Eighty-five patients were enrolled (UGPG n = 47; SCPG n = 38). \u0394VTI acquisition was completed within the intended time window in all enrolled patients, establishing bedside feasibility. Across the whole cohort, \u0394VTI discriminated non-survivors poorly (AUC 0.55, 95% CI 0.44\u20130.66), and its performance differed markedly by group: AUC 0.83 (95% CI 0.67\u20130.93) in SCPG versus 0.69 (95% CI 0.54\u20130.82) in UGPG. In SCPG, non-survivors had substantially higher \u0394VTI than survivors (58.6 \u00b1 30.5% vs. 28.4 \u00b1 30.9%; p = 0.030), a pattern consistent with persistent, uncorrected fluid responsiveness. In UGPG, the association ran in the opposite direction, mortality being concentrated among \u0394VTI &lt; 10% non-responders (p = 0.020). Conclusions: \u0394VTI-guided resuscitation is feasible in the ED management of UGIB. The direction of the \u0394VTI\u2013mortality association differed according to whether \u0394VTI was visible to clinicians, generating the testable hypothesis that unrecognised fluid responsiveness contributes to death in standard care. These findings are hypothesis-generating only: the small sample and the low number of events preclude any causal inference and require confirmation in an adequately powered, randomised, etiology-stratified trial.<\/jats:p>","DOI":"10.3390\/life16081236","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:49:27Z","timestamp":1785131367000},"page":"1236","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Ultrasound-Guided Mini Fluid Challenge via Velocity\u2013Time Integral to Assess Fluid Responsiveness in Upper Gastrointestinal Bleeding: A Prospective Quasi-Experimental Feasibility Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1598-0676","authenticated-orcid":false,"given":"Ilker","family":"\u00c7ermikli","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Sile State Hospital, Istanbul 34980, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7858-8081","authenticated-orcid":false,"given":"Tufan","family":"Alatli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medicine Faculty, Balikesir University, Balikesir 10145, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3757-2611","authenticated-orcid":false,"given":"Salih","family":"Kocaoglu","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Medicine Faculty, Balikesir University, Balikesir 10145, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e11656","DOI":"10.7717\/peerj.11656","article-title":"Prediction model of emergency mortality risk in patients with acute upper gastrointestinal bleeding: A retrospective study","volume":"9","author":"Chen","year":"2021","journal-title":"PeerJ"},{"key":"ref_2","first-page":"55","article-title":"Causes, Morbidity, and Mortality of Upper Gastrointestinal Bleeding Among Hospitalized Patients","volume":"5","author":"Khan","year":"2024","journal-title":"BMC J. Med. Sci."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1016\/j.giec.2011.07.004","article-title":"Epidemiology and demographics of upper gastrointestinal bleeding: Prevalence, incidence, and mortality","volume":"21","author":"Sostres","year":"2011","journal-title":"Gastrointest. Endosc. Clin. N. Am."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"805","DOI":"10.7326\/M19-1795","article-title":"Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the International Consensus Group","volume":"171","author":"Barkun","year":"2019","journal-title":"Ann. Intern. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1186\/s13054-019-2545-z","article-title":"Functional hemodynamic tests: A systematic review and a meta-analysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness","volume":"23","author":"Messina","year":"2019","journal-title":"Crit. Care"},{"key":"ref_6","unstructured":"Alatl\u0131, T. (2023). \u00d6ny\u00fck \u00f6l\u00e7\u00fcm\u00fc ve s\u0131v\u0131 yan\u0131t\u0131 de\u011ferlendirmede mini s\u0131v\u0131 y\u00fckleme testi (mini fluid challenge test) yeri ve kullan\u0131m alan\u0131. Yo\u011fun Bak\u0131mda \u0130leri Hemodinamik Monit\u00f6rizasyon, T\u00fcrkiye Klinikleri. [1st ed.]."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1186\/s13613-018-0427-1","article-title":"Respiratory changes of the inferior vena cava diameter predict fluid responsiveness in spontaneously breathing patients with cardiac arrhythmias","volume":"8","author":"Bortolotti","year":"2018","journal-title":"Ann. Intensive Care"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1055\/a-1369-5274","article-title":"Endoscopic diagnosis and management of nonvariceal upper gastrointestinal hemorrhage (NVUGIH): European Society of Gastrointestinal Endoscopy (ESGE) Guideline\u2014Update 2021","volume":"53","author":"Gralnek","year":"2021","journal-title":"Endoscopy"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1056\/NEJMoa1211801","article-title":"Transfusion strategies for acute upper gastrointestinal bleeding","volume":"368","author":"Villanueva","year":"2013","journal-title":"N. Engl. J. Med."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/j.afjem.2020.06.004","article-title":"Clinical mortality risk factors of variceal upper gastrointestinal bleeding in a Malagasy surgical intensive care unit","volume":"10","author":"Rakotondrainibe","year":"2020","journal-title":"Afr. J. Emerg. Med."},{"key":"ref_11","first-page":"e13521","article-title":"Acute upper gastrointestinal bleeding in hexagenarians or older (\u226560 years) versus younger (<60 years) patients: Clinico-endoscopic profile and outcome","volume":"13","author":"Yadav","year":"2021","journal-title":"Cureus"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1097\/SHK.0b013e3181b8569d","article-title":"Assessing Shock Resuscitation Strategies by Oxygen Debt Repayment","volume":"33","author":"Ward","year":"2010","journal-title":"Shock"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1002\/j.2040-4603.2021.tb00162.x","article-title":"Physiology of Human Hemorrhage and Compensation","volume":"11","author":"Convertino","year":"2021","journal-title":"Compr. Physiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1661","DOI":"10.1161\/CIRCULATIONAHA.119.040631","article-title":"Assessment and Treatment of Patients with Type 2 Myocardial Infarction and Acute Nonischemic Myocardial Injury","volume":"140","author":"DeFilippis","year":"2019","journal-title":"Circulation"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/liv.12021","article-title":"Pathological Bacterial Translocation in Cirrhosis: Pathophysiology, Diagnosis and Clinical Implications","volume":"33","author":"Bellot","year":"2013","journal-title":"Liver Int."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Noor, A., Liu, M., Jarman, A., Yamanaka, T., and Kaul, M. (2025). Point-of-Care Ultrasound Use in Hemodynamic Assessment. Biomedicines, 13.","DOI":"10.3390\/biomedicines13061426"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1186\/s13054-023-04495-6","article-title":"Diagnostic accuracy of point-of-care ultrasound for shock: A systematic review and meta-analysis","volume":"27","author":"Yoshida","year":"2023","journal-title":"Crit. Care"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"477","DOI":"10.1111\/jgh.70224","article-title":"Blood Urea Nitrogen-to-Creatinine Ratio to Differentiate Upper From Lower Gastrointestinal Bleeding: A Systematic Review and Meta-Analysis","volume":"41","author":"Simadibrata","year":"2026","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e31543","DOI":"10.1097\/MD.0000000000031543","article-title":"Acute gastrointestinal bleeding: A comparison between variceal and nonvariceal gastrointestinal bleeding","volume":"101","author":"Popescu","year":"2022","journal-title":"Medicine"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1007\/s12664-022-01290-z","article-title":"Analysis of the patients with nonvariceal upper gastrointestinal bleeding and comparison of Rockall and Glasgow-Blatchford scores","volume":"41","author":"Aktas","year":"2022","journal-title":"Indian J. Gastroenterol."}],"container-title":["Life"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1236\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T06:05:30Z","timestamp":1785132330000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-1729\/16\/8\/1236"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":20,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["life16081236"],"URL":"https:\/\/doi.org\/10.3390\/life16081236","relation":{},"ISSN":["2075-1729"],"issn-type":[{"value":"2075-1729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]}}}