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Publication Lung ultrasound reproducibly outperforms computed tomography in the detection of extravascular lung water in patients undergoing haemodialysis(MDPI, 2024-03-11) Corcoran, John P.; Hew, Mark; Attwood, Ben; Shyamsundar, Murali; Sutherland, Sheera; Ventura, Kristine; Benamore, Rachel; St Noble, Victoria; Piotrowska, Hania E.; Pugh, Christopher W.; Laursen, Christian B.; Gleeson, Fergus V.; Rahman, Najib M.; Oxford University Hospitals NHS Foundation Trust; University of Oxford; The Alfred Hospital, Melbourne, Australia; Monash University, Melbourne, Australia; South Warwickshire University NHS Foundation Trust; Queen's University Belfast; Odense University Hospital, Denmark; University of Southern Denmark; Anaesthesia and Intensive Care; Medical and Dental; Attwood, BenBackground: Lung ultrasound (LUS) is increasingly used as an extension of physical examination, informing clinical diagnosis, and decision making. There is particular interest in the assessment of patients with pulmonary congestion and extravascular lung water, although gaps remain in the evidence base underpinning this practice as a result of the limited evaluation of its inter-rater reliability and comparison with more established radiologic tests. Methods: 30 patients undergoing haemodialysis were prospectively recruited to an observational cohort study (NCT01949402). Patients underwent standardised LUS assessment before, during and after haemodialysis; their total LUS B-line score was generated, alongside a binary label of whether appearances were consistent with an interstitial syndrome. LUS video clips were recorded and independently scored by two blinded expert clinician sonographers. Low-dose non-contrast thoracic CT, pre- and post dialysis, was used as a "gold standard" radiologic comparison. Results: LUS detected a progressive reduction in B-line scores in almost all patients undergoing haemodialysis, correlating with the volume of fluid removed once individuals with no or minimal B-lines upon pre-dialysis examination were discounted. When comparing CT scans pre- and post dialysis, radiologic evidence of the change in fluid status was only identified in a single patient. Conclusions: This is the first study to demonstrate that LUS detects changes in extravascular lung water caused by changing fluid status during haemodialysis using a blinded outcome assessment and that LUS appears to be more sensitive than CT for this purpose. Further research is needed to better understand the role of LUS in this and similar patient populations, with the aim of improving clinical care and outcomes. Keywords: extravascular lung water; interstitial syndrome; lung ultrasound.Publication Point of care ultrasound : current and future directions for acute medicine(Rila Publications Ltd, 2023-06-12) Biart, Simon; Stanley, Florina; Rahman, Latif; Jones, Hattie; Smallwood, Nicholas; Liverpool University Hospitals NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; University Hospitals Leicester; Royal Berkshire NHS Foundation Trust; Hampshire Hospitals NHS Foundation Trust; Acute Internal Medicine; Medical and Dental; Stanley, FlorinaPoint of care ultrasound (POCUS) represents an exciting tool for current and future acute care practitioners. POCUS has come a long way in a short space of time and its widespread implementation may well be one of the biggest changes seen in acute medicine across the next decade. This narrative review explores the increasing evidence base for the accuracy of POCUS use in various acute scenarios, whilst also addressing current gaps in the evidence and areas for potential future POCUS development.Publication Introducing early and structured rehabilitation in critical care : a quality improvement project(SpringerOpen, 2017-09-20) McWilliams, D.; Snelson, C.; Goddard, H.; Attwood, B.; University Hospitals Birmingham NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Physiotherapy; Intensive Care; Allied Health Professional; Medical and Dental; Goddard, H.; Attwood, B.Meeting abstract 1045 of ESICM LIVES 2017: 30th ESICM Annual Congress, Budapest, Hungary, September 23-27, 2017.Publication Can patient safety be improved by reducing the volume of “inappropriate prescribing tasks” handed over to out-of-hours junior doctors?(Taylor and Francis Group, 2018-03-20) Amis, Samuel M.; Osicki, Tobin; South Warwickshire University NHS Foundation Trust; Acute Internal Medicine; Medical and Dental; Amis, Samuel Martin; Osicki, Tobin Henry EdgarBackground: First-year doctors found that during out-of-hours shifts they were being delayed and distracted from reviewing potentially sick/deteriorating patients by a high volume of prescribing tasks. This predominately consisted of oral anticoagulation prescribing and rewrites of drug charts. We hoped that if we could reduce this burden of "inappropriate prescribing tasks", we could not only improve junior doctors' job satisfaction and opportunities for training but also give them more time for patient reviews. Methods: Three weekends were initially audited to quantify the number of "inappropriate prescribing tasks" using data from the hospital's computerized task assigning system. On three subsequent weekends, a checklist was handed out to the ward teams on Friday mornings. This checklist was designed to encourage the day teams to check that drug charts would not need oral anticoagulation or rewriting over the weekend. Results: An overall reduction in "inappropriate prescribing tasks" of 46% with a specific reduction in inappropriate oral anticoagulation prescribing of 65% was observed. Inappropriate drug chart rewrites were reduced by 30%. The reduction in the mean number of pre-intervention inappropriate prescribing tasks (as a percentage of total prescribing tasks) and the post-intervention mean was 6.94% (95% confidence interval -0.54 to 14.42, p-value=0.062). Conclusion: Improved job satisfaction and a perceived reduced workload were noted from post-intervention qualitative surveys. While improved patient safety directly resulting from this intervention is more difficult to establish, and the observed reduction in inappropriate prescribing was only approaching statistical significance, our colleagues commented in post-intervention feedback that they felt they had more time, and felt less pressured, while attending patients. The workload of junior doctors can exert a significant effect on patient care, and simple measures can alleviate this burden. Furthermore, computerized hospital task management systems are an underutilized source of data for audit and quality improvement. Keywords: anticoagulation; checklist; drug-chart; on-call; workload.Publication The impact of a dedicated multidisciplinary social media team at a national critical care conference(SAGE Publications, 2019-05) Moses, Rachael; Abbey, Aoife; Arora, Nitin; Cronin, Robert; Mathieu, Steve; Suntharalingam, Ganesh; Strachan, Jamie; Sanghera, Tanjinder; Downham, Jonathan; Lancashire Teaching Hospital NHS Trust; Queen Elizabeth Hospital, Birmingham; Heartlands Hospital, Birmingham; Gloucestershire Hospitals NHS Foundation Trust; Portsmouth Hospitals NHS Trust; London North West University Hospitals; Oxford University Hospitals NHS Foundation Trust; Barts Health Trust, London; South Warwickshire University NHS Foundation Trust; Intensive Care Unit; Nursing and Midwifery Registered; Downham, JonathanEPoster abstract EP.158 of the Intensive Care Society State of the Art Meeting, Dec 10-12, 2018, London, UK.Publication Clinical practice evaluation of osteomyelitic diabetic foot ulcers (DFU) managed through an outpatient parenteral antimicrobial therapy (OPAT) service(Wiley, 2019-03-05) Page, Tristan; Dillon, Helen M.; Baskar, Varadarajan; Wilkinson, J.; Jones, Effie; Dikko, Mohammed; Higman, D.; Mahto, Rajni; South Warwickshire University NHS Foundation Trust; University Hospitals Coventry and Warwickshire NHS Trust; Diabetes; Acute Medicine; Endocrinology; Podiatry; Orthopaedics; Allied Health Professional; Medical and Dental; Page, T.; Dillon, H.; Baskar, V.; Jones, E.; Dikko, M.; Mahto, R.This abstract from the Diabetes UK Professional Conference 2019 documents the authors' experience of managing osteomyelitic diabetic foot ulcer (DFU) patients treated with outpatient parenteral antimicrobial therapy (OPAT) support in line with local antimicrobial policy.Publication Online Multidisciplinary Review of Point of Care Ultrasound Images During the COVID-19 Pandemic(Oxford University Press, 2021-04) Shuker, B.; Perry, Justin; South Warwickshire University NHS Foundation Trust; Anaesthetics; Medical and Dental; Shuker, B. A.; Perry, J.Point-of-care-ultrasound (POCUS) is a valuable diagnostic tool in intensive care. Evaluation of POCUS images acquired in our intensive care unit (ICU) prior to the COVID-19 pandemic had typically been performed solely at the point of care. Where further evaluation was required, cross-sectional thoracic imaging or departmental echocardiography would be requested. Clinicians also had access to ICU ultrasound machines for review of images, or to repeat studies for clarification of findings. However, the nature of the pandemic limited access to ICU to minimise contact with COVID-19. Objectives We aimed to develop an online solution for review of POCUS images by the multidisciplinary team (MDT). Methods Microsoft Teams was utilised to create a dedicated channel for the MDT to review POCUS images. Images were exported from ultrasound machines used inside our ICU to portable USB drives in standard formats (DICOM or WMV). The portable USB drives were decontaminated prior to transfer outside of the ICU. Anonymised images were uploaded with relevant clinical details to the Teams platform for MDT review. Results The online platform provided rapid access to images for review by the MDT. POCUS images from ICU patients with and without COVID-19 were reviewed. MDT review frequently led to a change in patient management. Significant examples included identification of a missed inferior vena cava thrombus leading to initiation of anticoagulation therapy, and rapid expert input for a case of cardiac tamponade. Conclusion The use of an online platform allowed our intensive care unit to establish a reliable method for images acquired from point-of-care-ultrasound to be remotely reviewed by an expert multidisciplinary team, consequently improving patient care.Publication Transferring critically ill Covid-19 patients in ITU - A multidisciplinary training exercise(Oxford University Press, 2021-04) Tebbett, Alex; Purcell, Ian; Watton, Shereen; Shanmugham, Rathinavel; South Warwickshire University NHS Foundation Trust; Critical Care; Anaesthetics; Medical and Dental; Nursing and Midwifery Registered; Tebbett, Alex; Purcell, Ian; Watton, Shereen; Shanmugham, RathinavelIntroduction During Covid-19 many staff members were redeployed to the Intensive Care Unit (ICU) with little opportunity to train in the new skills they would require. One such skill was the transfer of a critically ill, and contagious, patient from ICU; a risky and complicated procedure which requires planning, preparation, risk assessment, situational awareness and, ideally, experience. To assist our colleagues in this skill an existing ICU transfer course has been adapted to cover the Covid-19 situation, or any similar contagious pandemic, in patient transfer. Methods An in-situ simulation method was chosen as the most realistic method of immersing our participants into the environment of ICU and to highlight real-life complexities and issues they may face. A multidisciplinary training session was devised so that novice anaesthetists, ACCPs and nurses could learn together, reflective of the usual team. Human factors such as communication, team leadership, task management and situational awareness are the focus of the post-simulation debrief, and human factors sheets have been created to guide the participants in analysing these skills. Pre- and post-simulation confidence, knowledge and attitudes will be assessed using validated appraisal tools and questionnaires to gather both quantitative and qualitative data about the experience. Discussion Multidisciplinary training is often difficult to arrange, due to the different requirements, processes, and procedures each department demands. A hidden blessing of Covid-19 is the realisation that this barrier can be broken, for the benefit of our patients and colleagues alike, and training sessions like this implemented.Publication Reducing Human factors in IV care by using passive disinfection caps(SAGE Publications, 2018-06) Kenion, R. A.; Beverley, S.; Waite, A.; South Warwickshire University NHS Foundation Trust; Acute Medicine; Nursing and Midwifery Registered; Kenion, R. A.; Beverley, S.; Waite, A.Poster abstract P128 from the 5th World Congress on Vascular Access WoCoVA 2018 June 20–22, 2018, Copenhagen, DenmarkPublication Introducing early and structured rehabilitation in critical care: a quality improvement project(Elsevier, 2019-08) McWilliams, David; Snelson, Catherine; Goddard, Hannah; Attwood, Ben; University Hospitals Birmingham NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Physiotherapy; Critical Care; Allied Health Professional; Medical and Dental; Goddard, Hannah; Attwood, Ben; Snelson, CatherineObjectives: To assess the potential impact of introducing an already established and effective programme of rehabilitation within a critical care unit in a different organisation. Design: Fifteen-month prospective before/after quality improvement project. Setting: Seven-bed mixed dependency critical care unit. Participants: 209 patients admitted to critical care for ≥4 days. Intervention: A multi-faceted quality improvement project focussed on changing structure and overcoming local barriers to increase levels of rehabilitation within critical care. Main outcome measure: Proportion of patients mobilised within critical care, time to first mobilise and highest level of mobility achieved within critical care. Results: Compared to before the quality improvement project, significantly more patients mobilised within critical care (92% vs 73%, p = 0.003). This resulted in a significant reduction in time to 1st mobilisation (2 vs 3.5 days, P < 0.001), particularly for those patients ventilated ≥4 days (3 vs 14 days) and higher mobility scores at the point of critical care discharge (Manchester mobility score 5 vs 4, p = 0.019). Conclusion: The results from this quality improvement project demonstrate the positive impact of introducing a programme of early and structured rehabilitation to a critical care unit within a different organisation. This could provide a framework for introducing similar programmes to other critical care units nationally. Keywords: Critical care; ICU; Implementation; Physiotherapy; Quality improvement; Rehabilitation.Publication Millennial learners - a blended approach to simulation for sepsis(Royal College of Physicians, 2020-02) Ventre, Rachel; Pardoe, Cleone; Cripps, David; South Warwickshire University NHS Foundation Trust; Medical Education; Simulation; Medical and Dental; Ventre, Rachel; Pardoe, Cleone; Cripps, DavidA qualitative pilot study into the use of video-based blended teaching of medics about sepsis.Publication Early sepsis identification following cytoreductive surgery for peritoneal malignancy(BMC, 2020-03) Wilson, Darius Cameron; Yershov, Danylo; Kandiah, Chandrakumaran; Cortes, Nicholas; Gordon, Kirsty; Saeed, Kordo; Vall d'Hebron Institut of Research, Barcelona, Spain; South Warwickshire University NHS Foundation Trust; Basingstoke Hospital; St Bernard's Hospital, Gibraltar; Hampshire Hospitals NHS Foundation Trust; University Hospital Southampton NHS Foundation Trust; Surgery; Medical and Dental; Yershov, DanyloA study into early sepsis identification following cytoreductive surgery for peritoneal malignancy.Publication Problems in care and avoidability of death after discharge from intensive care: a multi-centre retrospective case record review study(BMC, 2021-01) Vollam, Sarah; Gustafson, Owen; Young, J. Duncan; Attwood, Ben; Keating, Liza; Watkinson, Peter; University of Oxford; National Institute for Health Research Biomedical Research Centre, Oxford; Oxford University Hospitals NHS Foundation Trust; South Warwickshire University NHS Foundation Trust; Royal Berkshire NHS Foundation Trust; Intensive Care; Medical and Dental; Attwood, BenjaminBackground: Over 138,000 patients are discharged to hospital wards from intensive care units (ICUs) in England, Wales and Northern Ireland annually. More than 8000 die before leaving hospital. In hospital-wide populations, 6.7-18% of deaths have some degree of avoidability. For patients discharged from ICU, neither the proportion of avoidable deaths nor the reasons underlying avoidability have been determined. We undertook a retrospective case record review within the REFLECT study, examining how post-ICU ward care might be improved. Methods: A multi-centre retrospective case record review of 300 consecutive post-ICU in-hospital deaths, between January 2015 and March 2018, in 3 English hospitals. Trained multi-professional researchers assessed the degree to which each death was avoidable and determined care problems using the established Structured Judgement Review method. Results: Agreement between reviewers was good (weighted Kappa 0.77, 95% CI 0.64-0.88). Discharge from an ICU for end-of-life care occurred in 50/300 patients. Of the remaining 250 patients, death was probably avoidable in 20 (8%, 95% CI 5.0-12.1) and had some degree of avoidability in 65 (26%, 95% CI 20.7-31.9). Common problems included out-of-hours discharge from ICU (168/250, 67.2%), suboptimal rehabilitation (167/241, 69.3%), absent nutritional planning (76/185, 41.1%) and incomplete sepsis management (50/150, 33.3%). Conclusions: The proportion of deaths in hospital with some degree of avoidability is higher in patients discharged from an ICU than reported in hospital-wide populations. Extrapolating our findings suggests around 550 probably avoidable deaths occur annually in hospital following ICU discharge in England, Wales and Northern Ireland. This avoidability occurs in an elderly frail population with complex needs that current strategies struggle to meet. Problems in post-ICU care are rectifiable but multi-disciplinary. Trial registration: ISRCTN14658054.Publication 282 Audit for the Management of Acute Gallstone Disease(Oxford University Press, 2022-02) Garner, J.; South Warwickshire University NHS Foundation Trust; Medical and Dental; Garner, J.Aim The aim of this audit was to investigate how patients referred by the Emergency Department (ED) with biliary disease were managed. Also, to identify a cohort of patients which could be safely discharged from ED with an outpatient US and follow up with the Surgical Assessment Unit. Method Data was collected from 23/11/20 to 11/12/20. The inclusion criteria were patients referred by ED with abdominal pain and a diagnosis of biliary disease. Data collected included blood results, US results and if they underwent a laparoscopic cholecystectomy (LC). Results There were 22 patients identified; 5 had biliary colic, 4 had cholangitis and 13 had cholecystitis. The 5 patients with biliary colic had almost completely normal bloods on admission. While 16/17 patients with cholecystitis/cholangitis had elevated FBC, CRP or LFTs. US was performed on 3 patients with biliary colic within 3 days of ED attendance. US was performed on 16/17 patients with cholecystitis/cholangitis, mainly within 2 days. None of the patients with biliary colic received antibiotics and 2 had an inpatient LC. All patients with cholecystitis and cholangitis were admitted and treated with antibiotics. 1 patient with cholecystitis had a LC and 7 were on the waiting list. Conclusions This has shown that patients are being imaged with US efficiently and are treated appropriately with antibiotics. It has demonstrated that a blood test in ED is effective at differentiating between biliary colic and other diseases that require admission. However, improvements need to be made to increase access for patients to undergo timely LCs.Publication How do we identify acute medical admissions that are suitable for same day emergency care?(Royal College of Physicians, 2022-03) Atkin, Catherine; Riley, Bridget; Sapey, Elizabeth; University of Birmingham; South Warwickshire University NHS Foundation Trust; University Hospitals Birmingham NHS Foundation Trust; Acute Medicine; Respiratory Medicine; Medical and Dental; Riley, Bridget; Sapey, ElizabethMedical emergencies causing unplanned hospital admission place considerable demands on acute healthcare services. Some patients can be assessed and treated through ambulatory pathways without inpatient admission, via same day emergency care (SDEC), potentially benefiting patients and reducing demands on inpatient services. There is currently considerable variation within acute medicine in aspects of SDEC delivery ranging from overall service design to patient selection methods. Scoring systems identifying patients likely to be successfully managed through SDEC services have been suggested, but evidence of utility in diverse populations is lacking. Specific scoring systems exist for some common medical problems, including cardiac chest pain and pulmonary embolism, but further research is needed to demonstrate how these are most effectively incorporated into SDEC services. This review defines SDEC and describes the variation in services nationally. It reviews the evidence for their clinical impact, tools to screen patients for SDEC and current gaps in our knowledge regarding service deployment.Publication Respiratory virus transmission using a novel viral challenge model: An observational cohort study(Elsevier, 2022-10) Medina, Marie-Jo; Nazareth, Joshua; Dillon, Helen M.; Wighton, Christopher J.; Bandi, Srini; Pan, Daniel; Nicholson, Karl G.; Clark, Tristan W.; Andrew, Peter W.; Pareek, Manish; University of Leicester; University Hospitals of Leicester NHS Trust; South Warwickshire University NHS Foundation Trust; University of Southampton; Medical and Dental; Dillon, Helen M.Objectives: Knowledge of Acute Respiratory virus Infection (ARI) is limited in relation to their substantial global burden. We completed a feasibility study of a novel method to study the natural transmission of respiratory viruses from young children to adults in hospital. Methods: Between September 2012 and May 2015, we recruited healthy adults (contacts) and paediatric inpatients with ARIs (index) presenting to the University Hospitals Leicester NHS Trust, Leicester, UK. We took nose and throat swabs from all participants prior to controlled, 30 minute interactions between the children with ARIs and adult contacts. Contacts recorded symptoms and provided four nose and throat swabs over ten days post-interaction, which were tested for a panel of respiratory viruses to assess transmission. Results: 111 interactions occurred between children with ARIs and adult contacts. Respiratory viruses were detected in 103 of 111 children (93%), most commonly rhinoviruses (RVs) (67 of 103, 65%). Transmission to an adult contact occurred in 15 (14·6%) of 103 interactions and was inversely associated with the contact being male (adjusted OR 0·12; 95% CI 0·02-0·72). Conclusion: Using a novel methodology, we found that natural transmission of ARIs occurred in 15% of an infected child's contacts following a 30 minute interaction, primarily by RVs and when the contact was female. Our model has key advantages in comparison with human challenge studies making it well-suited for further studies of respiratory virus transmission, disease pathogenesis, and clinical and public health interventions to interrupt transmission.Publication FUSIC HD. Comprehensive haemodynamic assessment with ultrasound(SAGE Publications, 2022-08) Miller, Ashley; Peck, Marcus; Clark, Tom; Conway, Hannah; Olusanya, Segun; Fletcher, Nick; Parulekar, Prashant; Aron, Jonathan; Kirk-Bayley, Justin; Wilkinson, Jonathan Nicholas; Wong, Adrian; Stephens, Jennie; Rubino, Antonio; Attwood, Ben; Walden, Andrew; Breen, Andrew; Waraich, Manprit; Nix, Catherine; Hayward, Simon; South Warwickshire University NHS Foundation Trust; et al.; Intensive Care; Medical and Dental; Attwood, BenFUSIC haemodynamics (HD) - the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the Intensive Care Society (ICS) - describes a complete haemodynamic assessment with ultrasound based on ten key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the training pathway and summarises the ten clinical questions. Further details are included in an online supplementary appendix.Publication A woman with syncope and acidosis(Wiley Open Access, 2022-11) Malik, Adnan Ather; Nanthakumar, Aran; Mahdi, Dana; Alluri, Sai Venkatesh; Dhungana, Salonee; Bleehen, Laura; Maynard, Charlsea; Butt, Umar; Chacko, Jerry; Ali, M. Adam; George Eliot Hospital NHS Trust; University Hospitals Coventry and Warwickshire NHS Trust; East Kent Hospitals University NHS Foundation Trusts; Barking Havering and Redbridge University Hospitals NHS Trust; South Warwickshire University NHS Foundation Trust; Royal College of Surgeons in Ireland; University Hospitals of Leciester NHS Trust; Royal Free London NHS Foundation Trust; Emergency Medicine; Surgical Services; Medical and Dental; Bleehen, Laura; Malik, Adnan AtherCase report on a woman with syncope and acidosisPublication Raised FGF23 correlates to increased mortality in critical illness, independent of vitamin D(MDPI, 2023-02-14) Thein, Onn Shaun; Ali, Naeman; Mahida, Rahul Y.; Dancer, Rachel C. A.; Ostermann, Marlies; Amrein, Karin; Martucci, Gennaro; Scott, Aaron; Thickett, David R.; Parekh, Dhruv; University of Birmingham; South Warwickshire University NHS Foundation Trust; Guy's & St Thomas' Hospital; Medical University of Graz; IRCCS-ISMETT; Acute Medicine; Respiratory; Critical Care; Medical and Dental; Dancer, Rachel C. A.; Thein, Onn Shaun; Mahida, Rahul Y.; Thickett, David R; Parekh, DhruvBackground: Fibroblast Growth Factor (FGF23) is an endocrine hormone classically associated with the homeostasis of vitamin D, phosphate, and calcium. Elevated serum FGF23 is a known independent risk factor for mortality in chronic kidney disease (CKD) patients. We aimed to determine if there was a similar relationship between FGF23 levels and mortality in critically ill patients. Methods: Plasma FGF23 levels were measured by ELISA in two separate cohorts of patients receiving vitamin D supplementation: critical illness patients (VITdAL-ICU trial, n = 475) and elective oesophagectomy patients (VINDALOO trial, n = 76). Mortality data were recorded at 30 and 180 days or at two years, respectively. FGF23 levels in a healthy control cohort were also measured (n = 27). Results: Elevated FGF23 (quartile 4 vs. quartiles 1-3) was associated with increased short-term (30 and 180 day) mortality in critical illness patients (p < 0.001) and long-term (two-year) mortality in oesophagectomy patients (p = 0.0149). Patients who died had significantly higher FGF23 levels than those who survived: In the critical illness cohort, those who died had 1194.6 pg/mL (range 0-14,000), while those who survived had 120.4 pg/mL (range = 15-14,000) (p = 0.0462). In the oesophagectomy cohort, those who died had 1304 pg/mL (range = 154-77,800), while those who survived had 644 pg/mL (range = 179-54,894) (p < 0.001). This was found to be independent of vitamin D or CKD status (critical illness p = 0.3507; oesophagectomy p = 0.3800). FGF23 levels in healthy controls were similar to those seen in oesophagectomy patients (p = 0.4802). Conclusions: Elevated baseline serum FGF23 is correlated with increased mortality in both the post-oesophagectomy cohort and the cohort of patients with critical illness requiring intensive care admission. This was independent of vitamin D status, supplementation, or CKD status, which suggests the presence of vitamin D-independent mechanisms of FGF23 action during the acute and convalescent stages of critical illness, warranting further investigation.