Background: Over the last half-decade, substantial breakthroughs have taken place in terms of routine therapy of critically ill patients. The combination of these strategies has the potential to result in improvement in the overall outcomes for patients in intensive care units. Methods: A focused review was undertaken of trials of interventions in critically ill patients with outcome endpoints. Results: This review discusses recent results related to transfusion avoidance, new drug therapy of sepsis, low tidal volume ventilation, tight glycemic control, early goal-directed resuscitation in sepsis, and the contribution of intensivists to improved outcomes. Conclusions: Appropriate incorporation of these strategies into everyday practice will likely result in improvements in the care of critically ill surgical patients.