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To evaluate perceptions of intensive care unit (ICU) workers from low-and-middle income countries (LMICs) and high income countries (HICs).A cross sectional design. Data collected from doctors using an anonymous online, questionnaire.Hundred seventy-five from LMICs and 43 from HICs participated. Barriers in LMICs were lack of formal training (Likert score median 3 [inter quartile range 3]), lack of nurses (3) and low wages (3). Strategies for LMICs improvement were formal training of ICU staff (4), an increase in number of ICU nurses (4), collection of outcome data (3), as well as maintenance of available equipment [3(3)]. The most useful role of HIC ICU staff was training of LMIC staff (4). Donation of equipment [2(4)], drugs [2(4)], and supplies (2) perceived to be of limited usefulness. The most striking difference between HIC and LMIC staff was the perception on the lack of physician leadership as an obstacle to ICU functioning (4 vs. 0, p < 0.005).LMICs ICU workers perceived lack of training, lack of nurses, and low wages as major barriers to functioning. Training, increase of nurse workforce, and collection of outcome data were proposed as useful strategies to improve LMIC ICU services.Barriers to smooth functioning of LMIC ICUs included lack of training, lack of nurses and low wages.Suggested strategies to improve functioning of LMIC ICUs included improving training, and availabilty of equipment.The most useful role of HIC ICU staff was perceived to be training of LMIC staff.Donation of equipment, drugs, and supplies was perceived to be of limited usefulness.The biggest contrast between HIC and LMIC staff was perception on lack of physician leadership as a barrier to ICU function.