More than 5000 participants from about 90 countries all around the world took part at the 30th International Symposium on Intensive Care and Emergency Medicine in Brussels, Belgium from March 9th to March 12th, 2010.  The declared goal of this meeting was to celebrate 30 years of intensive care and emergency medicine and hopefully help plan the next 30 years.

Professor Jean-Louis Vincent, head of the Department of Intensive Care Medicine at Erasme Hospital and congress president took the opportunity to look back, “The last 30 years have enabled us to understand better the pathophysiological processes leading to organ dysfunction and failure. The evolution of intensive care medicine during that time has been marked more notably by a decrease in the intensity of our interventions (less invasive monitoring, less aggressive mechanical ventilation, reduced transfusions, less sedation) than by the addition of new therapies. Acute medicine has an important place in the global healthcare journey. We have improved efficacy in situations where time is crucial (early resuscitation of trauma patients and patients with sepsis, myocardial infarction, cerebral thrombosis).  Prevention of complications has also improved (pulmonary embolus, nosocomial infections). The process of care has become more humane, and we pay more attention to the squelae of critical illness, both psychologic and somatic,” he said.

He and other lectures looking ahead said the most serious problems intensive care medicine would have to address were probably new treatments of severe infections, better organ support by extra- or intracorporeal systems, better interaction between extra- and intrahospital medicine and help for development of intensive care medicine  in developing countries.
I agree with Prof Vincent’s analysis, but it does not include my personal feelings towards intensive care medicine.  My commitment towards critical care is no smaller than it was nearly thirty years ago, but the enthusiasm that nearly everything can be done that spurred my first years in the field has been replaced by the insight to the huge limitations of intensive care medicine.

It was interesting to talk to colleagues from African developing countries who know about the very basic needs and deficits of the health care systems in their countries in detail and who were all the same absolutely fascinated by the new emerging possibilities of intensive care medicine.

Georg Röggla is an associate editor with the BMJ.