Children’s Critical Care Medicine is at a crucial point in its history. Following three decades of progress, wide variability remains in the quality of pediatric critical care practiced throughout this country. This arises from the isolated and urgent nature of critical care practice.

In general, critical care is provided in the setting of a large, pressing clinical work load managed by a small number of intensivists at any single location. These practitioners develop close relationships and similar practices. They develop their own distinct "unit" style.

No single intensivist or group sees sufficiently large numbers of patients with any particular illness to prospectively determine the best medical practice. Pediatric critical care medicine is practiced in isolated, scattered centers of varying quality with poor communication. Academic Centers of excellence also practice in isolation. Their "cutting edge" practice often remains unchallenged and unshared.

Critical Care Societies such as The Society of Critical Care Medicine, and the Critical Care Colloquium have attempted to address this problem by providing forums of collegiality to encourage the exchange of ideas. They have attempted to foster research to benefit those patients for whom pediatric intensivists are responsible.

Nevertheless, the challenge of how to provide technologically sophisticated care in a medically compassionate environment for these most ill of children, remains difficult and often ambiguous. There have been few national studies, there are no national patient management protocols. "Quality" is poorly defined. Communication barriers on an information super-highway must be overcome.