INTRODUCTION

In most modern children’s hospitals, the practice of paediatric critical care medicine occurs in a high technology, resource intensive environment “beyond the double doors”. Few venture into this foreboding environment without good reason. However, recognition that critical illness is a dynamic process behoves us to step “outside” and attempt to decrease the need for our services “inside”. Therefore, it gives me great pleasure to state that my colleagues (1) have gotten the message.
      As Pierre and Augier state in a previous issue of the Journal, critical illness defines evolving pathophysiologic derangements which if uninterrupted may ultimately lead to death and disability (1). It is well recognized that regardless of the inciting insult, severe organ dysfunction will eventually lead to cardiorespiratory compromise and failure.