Pediatric intensive care units across the world care for large numbers of mechanically ventilated infants and children on a daily basis, yet management of these patients is far from standardized. This lack of standardization may be a necessity in certain situations given variation between underlying disease processes, pathophysiology, response to therapy and available resources. However, there are many situations in which similar patients are managed differently across pediatric intensive care units simply because there are a shortage of available data to guide the management of these critically ill infants and children. Thus, a large fraction of pediatric critical care involves a combination of institutional preference, individual experience, opinion and extrapolation of adult data.