Optimum ICU design has pivotal role in critical care delivery that has major impact on physical and psychological health of the patients, physicians and other related staf. Its tsructure formation is complex and demands the dedicated involvement of not only care providers but also a trained and multi-professional team of architect, engineer and information technologists, etc. This paper tracks the journey from traditional design to recent advances in building the intensive care unit. The limitations in ICU design observed in the lower to middle income countries will also be discussed in this review. Specialist hospital architects are scarce in these countries and the ordinary civil engineering does not impart adequate coaching on matters related to lay-out plans as well as the various minute details about ifttings and provisions. Hence, it becomes imperative for the anesthesiologists and other healthcare providers to come to guide and assistance to the architects involved in designing the blue prints. It may only be possible if they have adequate knowledge and professional experience.