Redefining success in the PICU: new patient populations shift targets of care.

Over the last 3 decades, mortality rates of children admitted to PICUs in North America have declined significantly. By this measure alone, PICUs have been extremely successful, offering children the best possibility for survival and recovery after life-threatening trauma and illness. Yet as mortality rates have declined, the PICU patient population has become steadily more complex. A recent analysis of admissions across 54 PICUs in the United States (n 5 52 791) revealed that 53% of critically ill children had underlying chronic, complex illnesses. This finding is supported by a secondary analysis of a national administrative database in the United States that revealed comorbid illness among critically ill children increased from 35% in 1997 to 41% in 2006. The emergence of this new population of critically ill children reflects the medical and technological advances of recent decades.