The technology and expertise are now within cost effective reach to allow inter-institutional data sharing. The creation of these knowledge bases will improve both the quality and quantity of data available for clinical practice and diminish many of the barriers to performing formal randomized trials. To this end we will create virtual PICU. This will be an exciting endeavour with more than enough work for all who are interested. This effort by its nature will be collaborative, open and accessible to pediatric criticall care practitioners.