Introduction — Critical Care: Problems, Boundaries and Outcomes

As we enter a new millennium and complete almost half a century since the first intensive care units were developed, the conjunction is an opportune occasion on which to reflect on past achievements and future goals for critical care. From one point of view, the extent of development has been enormous. The discipline has evolved from a service provided opportunistically in ward areas set aside for polio victims receiving cuirasse ventilation (the iron lung), to a speciality managing complex patients with multiple organ failure in purpose-built units. Critical care complexes are now the focal point of many modern hospitals, and have an important rate-limiting effect on complex surgery and overall patient throughput. There have been many achievements during this period in the fields of pathophysiology, therapeutics, technology, epidemiology and clinical measurement, including case mix adjustment. Intensive care has become a multidisciplinary speciality and accounts for a substantial proportion of health care expenditure in many countries [1].

“ Men make history, and not the other way around. In periods where there is no leadership, society stands still Progress occurs when courageous, skillful leaders seize the opportunity to change things for the better.” (Harry S Truman).