Landmark events in critical care medicine such as arterial blood gas analysis, invasive mechanical ventilation, and renal dialysis define key timepoints along the evolution to modern, complex, and multi-professional critical care. Advances across multiple disciplines have driven care innovations, enhanced understanding of disease-specific pathophysiology, and improved outcomes. This review explores those drivers as they relate to surgical disease management and their impact on critical care medicine as a discipline. Discoveries in ultrasound, resuscitation and coagulopathy management, endotheliopathy, Acute Care Surgery, open body cavity management, extracorporeal techniques, emergency preservation and resuscitation (EPR), the human microbiome, surgical infections, chronic critical illness (CCI), disaster management, and solid organ transplantation all influence management in ICUs around the world. Each of these domains has also impacted the content and trajectory of the Society of Critical Care Medicine (SCCM)’s flagship journal, Critical Care Medicine over the last 50 years. A hallmark aspect of critical care as a concept—and not a location—is that both knowledge and care approaches that blossom within one parent discipline readily find fertile ground within others to improve the care of the critically ill and injured. This article explores how key elements of surgical science have developed, shaped critical care across disciplines and locations, and specifically informed the readers of Critical Care Medicine as part of the journal’s 50th Anniversary celebratory series.