An ICU is a geographically distinct area of a hospital where critically ill and injured patients undergo continuous monitoring and support of failing organ systems. The critical care team applies physiologically based interventions, monitor the response to these interventions, which then serves as the basis for further interventions. It is therefore clear that critical care medicine can only be practiced at the bedside; office based and remote “intensivists” have no place looking after critically ill patients. While a number of ICU organizational models exist the optimal model requires the frequent presence of intensivists at the patient’s bedside supported by a multidisciplinary team of health care professionals.

Patients in the ICU need to be managed by doctors who can see the “big picture”, be able to integrate and understand the patients’ complex mufti-system disease and formulate an integrative plan that is evidence-based, systematic and is in keeping with the patients’ treatment goals and values while be consistent with reality. This chapter reviews the concepts and basic interventions which should be addressed when admitting the “generic patient” to the ICU. A number of issues need to be addressed regardless of the type of ICU to which the patient is being admitted and the patient’s diagnosis.

It is important to note that no two patients are ever the same and that patients’ don’t read medical textbooks or “policies and procedures”. Furthermore, patients respond differently to the same intervention. Each patient’s care must therefore be individualized based on the patient’s unique demographics, co-morbidities, acute disease processes, response to physiological based interventions’ and their values and goals. “Policies and procedures” and “bundles of care” have a limited place in the ICU. Parallels are often drawn between the airline industry and the practice of medicine. In general, this is a dangerous position to take; patients are not airplanes and doctors are not pilots [1]. Each patient is different and will not respond to the same intervention in a stereotypical manner.