The origins of intensive care medicine as a clinical specialty involved essential contributions from anesthesiologists. Similarly research contributions from anesthesiologists have been of fundamental importance in identifying the underlying pathophysiology of critical illness and in determining effective treatment modalities. The individuals who were instrumental in the evolution of research into critical illness built upon the fundamental concept articulated and supported by the founding fathers of modern anesthesiology practice, including Robert D. Dripps, M.D., James E. Eckenhoff, M.D., LeRoy D. Vandam, M.D., Henry K. Beecher, M.D., and others. These giants clearly articulated a vision in which the foundation of the practice of anesthesiology relies on ongoing research into fundamental human responses to disease and physiologic and pathophysiologic perturbation.

Contributions to critical care research often began with the work of anesthesiologists not directly involved in the care of the critically ill. These investigations involved studies into the behavior of organ systems and molecules. For example, John W. Severinghaus, M.D., renowned pioneer anesthesiologist from the University of California-San Francisco (UCSF), has performed seminal studies on pulmonary gas exchange, acid-base disturbances, pulmonary vascular responses and a host of other topics. His findings continue to affect the practice of intensive care medicine on a daily basis.

On the other hand, clinically oriented investigators also have changed the practice of critical care. The contributions of Henning Pontoppidan, M.D., Henrik Bendixen, M.D., and others to our understanding of acute respiratory failure highlight the importance of applying basic principles to the study of patient disease. Another key example is the work of John B. Downs, M.D., M.E. Douglas, M.D., and Robert R. Kirby, M.D., in the development of intermittent mandatory ventilation, positive end-expiratory pressure, airway pressure release and a host of other essential modifications to mechanical support of ventilation.

Contributions have not been limited to the respiratory system. Peter Safar, M.D., and his colleagues developed the concept of cardiopulmonary resuscitation (CPR), performed essential investigations into the factors that aid the restoration of cardiac performance and examined fundamental mechanisms by which circulatory failure damages the brain. Other anesthesiologists have studied cardiac performance, determinants of circulatory tone and perfusion and the etiology of hepatic and renal dysfunction in the critically ill.

Anesthesiologists in countries other than the United States have likewise made some of the most important contributions to critical care research. In Europe intensive care medicine is viewed as a fundamental part of anesthesiology practice, a view not widely held in this country. In Italy, Luciano Gattinoni, M.D., and colleagues have explored the treatment of respiratory failure in acute respiratory distress syndrome (ARDS), have proposed some of the most dramatic treatment options and have investigated underlying pathophysiologic alterations. In Belgium Jean-Louis Vincent, M.D., has provided essential information on cardiovascular abnormalities in shock, has examined the use of different forms of exogenous circulatory support and has been a key participant in some of the most important multicenter clinical trials on treatments for sepsis and ARDS. Julian F. Bion, M.D., and colleagues in Britain have examined the research into the education of CPR providers and the provision of critical care services in a climate of scarcity. Others from Germany, Canada, Ireland, Israel and Japan also have made essential contributions.

A new generation of investigators in the United States has provided additional and important contributions to the understanding and treatment of the critically ill patient. Most recently this development involved a group of individuals who, using funding from the National Institutes of Health (NIH), has examined basic mechanisms that underlie critical illness. Richard S. Hotchkiss, M.D., Washington University, St. Louis, Missouri, has examined the critical role of programmed cell death, or apoptosis, in sepsis. Jeanine P. Wiener-Kronish, M.D., at UCSF, has examined the factors that contribute to bacterial pathogenicity in pneumonia. Jeffrey S. Balser, M.D., Vanderbilt University, Nashville, Tennessee, has made extremely important contributions regarding the biochemical and cellular determinants and treatment of cardiac arrhythmias. H. Thomas Lee, M.D., Ph.D., at Columbia University, New York, New York, has investigated the contributions of various insults and compounds to renal dysfunction. My own investigations have studied the molecular basis for hepatic dysfunction in sepsis and the use of gene therapy as a treatment for ARDS. In addition my colleague Yoram G. Weiss, M.D., at Hadassah Medical Center in Jerusalem, Israel, has examined gene therapy for ARDS. On the clinical level, Peter J. Pronovost, M.D., Ph.D., at Johns Hopkins, Baltimore, Maryland, has provided seminal studies into the determinants of outcome in the intensive care unit. These activities highlight just a few of the many ongoing investigations conducted by anesthesiologist-intensivists. The commitment of NIH and affiliated agencies to funding critical care research is clear.

An even newer generation of individuals is now moving to the forefront of critical care research. For example, Sean M. Berenholtz, M.D., at Johns Hopkins is investigating blood conservation strategies. Richard J. Levy, M.D., at The Children’s Hospital of Philadelphia is examining the biochemical mechanisms underlying cardiac dysfunction. Avery Toung, M.D., at the University of Chicago is studying the contribution of wake-sleep cycles. These individuals represent the future.

Adding to the optimism regarding research conducted by anesthesiologist-intensivists is the inauguration of the American Society of Critical Care Anesthesiologists/Foundation for Anesthesia Education and Research/Abbott Laboratories award in Critical Care Research. This award provides two years of salary support for a promising young investigator to pursue research training in a topic related to critical care. This year’s recipient, the first ever, is Guido Musch, M.D., from Massachusetts General Hospital, Boston, Massachusetts. His proposal is titled “Regional Effects of Alveolar Recruiting Strategies on Gas Exchange and Cellular Inflammation in Acute Lung Injury.”

With the addition of this new mechanism, the ongoing commitment of individuals to the performance of research into critical care medicine and the emergence of new, motivated, well-trained researchers, the future is bright indeed.

Clifford S. Deutschman, M.D., is Professor of Anesthesia and Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania.