ABSTRACT
PURPOSE OF REVIEW: Critical care is a young specialty. It emerged less than 50 years ago in response to new technologies that could prolong the survival of patients who previously would have died. The diseases that posed this threat to life were varied and the original practitioners of critical care came from a variety of medical backgrounds, and created a multidisciplinary specialty. As it continues to evolve, however, the participation and influence of surgeons is waning. CONTENT: We have sought the perspectives of an international group of intensivists on the role of surgeons in the future of critical care. These perspectives are varied. Surgeons play the largest role in North American critical care, although even here that role is diminishing, and new models of practice are needed. Surgical involvement is even less in Japan, Europe, and South America. The important role of the surgical perspective in differentiating heroic from futile intervention is underlined by Alsanea from Saudi Arabia. CONCLUSIONS: Surgical involvement in the practice of critical care is declining around the world. The reasons are complex, and include competing clinical imperatives, economics, and the demands of training programs. New models are needed to revitalize critical care as a multidisciplinary specialty.