In addition to the academic and informatics challenges that face critical care medicine, there are significant economic ones. The provision of critical care for children is economically threatened. In economically challenged environments, childrens health care is frequently one of the first victims. The needs of children often become political exigencies.

Intensivists must provide this technologically sophisticated, life enhancing care in an economically responsible fashion. The national environment mandates solutions to this medical challenge in a market environment. This is a critical challenge to childrens critical care medicine.

To meet this challenge the best therapy based, on the best information, in the least expensive fashion, for all children who will benefit from critical care, must be provided. To do this we must define the "best", most cost efficient therapy as well as define and understand who will really "benefit" from such care. This mandates information sharing and outcomes based research.

The answer to the economic challenge is collaborative research. No single ICU can possibly have enough experience in a realistic time to compare therapies, observe long term outcomes, alter interventions and determine who benefits, much less do it in a cost efficient way.

Large scale, collaborative data analysis is necessary to understand the variation of the critical care process and to minimize variation over time while optimizing childrens care. Improved quality and efficiency are necessary to provide the best care at the least cost.