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To provide an update on new developments in the field of pediatric intensive care.Pediatric intensive care and acute medicine continues to grow internationally with improving intensive care unit mortality rates (2.4% in the United States) and a positive effect on child survival from the leading causes of death in the developing and developed world (sepsis and trauma, respectively). New approaches have developed for the practicing clinician in the use of hypothermia, helium, surfactant, glucose, insulin, hydrocortisone, fluid resuscitation and fluid removal, superior vena cava oxygen saturation, goal-directed, coagulation, immune modulation, and multiple-organ extracorporeal support (MOSES) therapies. Some old drugs have fallen out of favor (propofol and etomidate) while new drugs are being evaluated with favorable (calfactant) and yet to be described effects (activated protein C). New diagnostic tests (troponin and brain natriuretic peptide levels) are being used to aid in diagnosis of heart dysfunction, and a new drug class of Ca++ sensitizers holds promise for recalcitrant heart dysfunction (levosimendan).The field is alive, successful, and progressing across the globe.