Pediatric Critical Care: Grand Challenges for a Glowing Future

Pediatric Critical Care is a relatively new field, tracing its origins to polio epidemics that killed large numbers of children, birthed by ongoing efforts in pediatric anesthesiology and neonatology, and nourished by parallel advances in pediatric pulmonology, cardiology, nephrology, adult critical care, general, cardiothoracic, neurosurgery, or other fields. Although not many PICUs existed before 1980 (Table 1)1-3, they now occupy a central position in the care of hospitalized children and in their improved survival from all types of medical/surgical conditions. Despite an overwhelmingly clinical focus and limited avenues for disseminating research, the numbers of PICU-related publications have increased steadily over the past 20 years, currently hovering around 5000 reports per year. Frontiers in Pediatric Critical Care seeks to disseminate the highest quality scholarly activity in this field, thus closing gaps between clinical practices and the high-level evidence supporting these practices. The four Grand Challenges include: 1. Fostering innovation in clinical medicine and technology 2. Translating basic research into new diagnostic/therapeutic tools 3. Defining short-term and long-term outcomes 4. Commitments to research, training, access to care Fostering innovation in clinical medicine and technology Recent discoveries elucidating the mechanisms of critical illness led to substantial advancements in pediatric critical care1,2, dramatically improving the outcomes of life-threatening illnesses or injuries in childhood. But now is not the time to rest on our laurels! Accelerating progress in multiple fields of biomedical and pharmaceutical sciences, imaging and computational sciences, biomaterials and bioengineering sciences must be coupled with an unrelenting pursuit of basic science and clinical research to translate these discoveries into improving the care of very sick children. Pediatric intensivists must remain at the forefront of developing or evaluating novel technologies, because of their unique perspectives gained from treating the whole patient and family, providing care at the end of life, and exposures to the entire ranges of demographics, medical/surgical conditions, and societal subgroups. Surveying the technological advances available for clinical application is impossible but two examples, regenerative medicine and personalized medicine are mentioned here. Innovation is rampant in interdisciplinary fields like stem cell therapy and regenerative medicine4-8, which will significantly impact future treatments for organ failures,