Pediatric Intensive Care Medicine combines aspects of the specialties of anesthesiology, pediatrics, pulmonology, cardiothoracic surgery and cardiology into one integrated and unique whole to provide care for the most severely ill children. Children whose very existence is immediately threatened have multiple aspects of the care they require in common, regardless of the underlying illness. Thus, children who have suffered trauma, heart disease, severe infectious disease, devastating medical illnesses or are recovering from surgery all benefit from the practice of critical care medicine.

Critical care provides respiratory support, hemodynamic control, neurologic protection and support of the whole child and family to assure optimal recovery from these life threatening challenges to the child's very existence. The urgency and the emotional milieu of critical illness in children have made prospective data gathering and research in critical care difficult and mostly nonexistent.

Critical illness in children frequently occurs acutely and de novo. With appropriate critical care medicine a child who had previously been a happy, healthy, functioning member of her family, has the prospect of returning to her family and becoming a fully integrated member of society. In addition, critical care medicine offers the hope that children can survive ever increasingly complex surgical procedures not possible in the past, such as cardiovascular and neurological surgery.

In the last twenty years pediatric critical care has addressed the issues of how to breathe for children unable to breathe for themselves. First new modes of mechanical ventilation were adapted from adult work. Subsequently, completely new theories of therapy, such as extra corporeal membrane oxygenation, liquid ventilation, high frequency oscillatory ventilation and other methods of advanced ventilatory techniques were established.

Increased understanding of the role that the pathophysiology of acute lung failure has been gained in children. These are continuing to grow rapidly. New approaches in one Center may take years to be available for all children. Every unit practices its own, idiosyncratic form of respiratory care.

In the area of cardiovascular support, new drugs and new techniques have supported childrens circulation allowing time for them to recover from such diverse processes as complex congenital heart disease, viral cardiomyopathies, overwhelming infection and surgical injury. These have allowed the development of ever sophisticated cardiac surgery to give children born with congenital heart disease hemodynamically normal hearts. Nevertheless there is little consensus on the best therapy in each of these circumstances. "Style" rules the patients' care.

In the area of neurological resuscitation children with brain injuries, which would have been fatal years ago, are now completely resuscitated and returned to normal, useful, functional life with minimal handicap. Children, who would not have survived, now survive to rejoin their families.

Similar advances have been made in caring for renal injury and hepatic injury. Of course, transplant surgery would be impossible without advanced critical care. In all of these advances multiple stylistic approaches have grown up which differ from institution to institution. There is slow diffusion of quality care. Further growth in critical care medicine will be difficult without improved evidence based medicine and data sharing to generalize excellence in the care children receive.