Pediatric critical care medicine is a surprisingly new subspecialty. While pediatric intensive care units (PICUs) were first developed in the late 1950s and early 1960s, pediatric critical care medicine did not emerge as a distinct discipline with its own subspecialty board certification until 1987. The field of pediatric critical care medicine has changed considerably over these last 26 years. The modern PICU of today is vastly different, even from as recently as 5 years ago. For example, many pediatric intensivists remember a time when cell phones were prohibited in the PICU, as they interfered with the circuitry of the monitors and life-support devices. Today, pediatric intensivists can often remotely monitor the status of their patients from these same cell phones. In fact, it is not hard to imagine that one day soon, pediatric intensivists will be able to remotely monitor and provide treatment recommendations for critically ill children several hundreds of miles away using handheld tablet computers or smart phones. Technological advances in monitoring have similarly changed almost overnight. Near-infrared spectroscopy, continuous venous oximetry, and pulse contour analysis have largely replaced the need for invasive hemodynamic monitoring using the pulmonary artery catheter. In the past, pediatric intensivists relied on a diagnostic assessment honed to perfection through years of experience. Now, pediatric intensivists routinely rely on a vast array of condition-specific biomarkers in order to begin treatment even before patients start to manifest classic signs and symptoms. Pediatric critical care medicine has indeed changed for the better and will undoubtedly continue to improve. Yet, even with all of the technological advancements and scientific achievements that will surely come in the future, the human element of what pediatric intensivists do will never change. For all of the science inherent in the specialty of pediatric critical care medicine, there is still art in providing comfort and solace to critically ill children and their families. No technology will ever replace the compassion in the touch of a hand or the soothing words of a calm and gentle voice. Therefore, in the pages that follow, a group of incredibly talented and gifted clinicians discuss both the art and the science of pediatric critical care medicine. On behalf of all of them, I give my sincerest and most humble thanks to all of the critically ill children and their families whom we have been blessed to call our patients. It has indeed been our privilege.
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