We thank Medeiros et al (1) for their insightful letter. This group of investigators has been among the world’s leaders in improving care of children with septic shock. Their analysis once again furthers this goal. We agree that guidelines are most effective when considered, applied, and reapplied in a “context” specific manner (2), in our article recently published in Critical Care Medicine. “Medicines Sans Frontieres” is the organization which first introduced me to the concept of “context-specific” guidelines. We are borrowing this effective and erudite approach from this wonderful humanitarian organization. Guidelines are a living document which should be developed and implemented in context.