My three Editor’s Choices articles from the June 2023 issue of Pediatric Critical Care Medicine (PCCM) focus on “what?” questions, including: long-stay patients with complex chronic conditions (CCC) or chronic critical illness (CCI); pulse oximetry measurements and race; and transcutaneous electrophysiologic monitoring of the diaphragm. The PCCM Connections for Readers focuses on the management of children with severe illness in resource-limited settings. WHAT ABOUT HAVING A PRIMARY PICU TEAM FOR COMPLEX AND LONG-STAY PATIENTS? Williams EP, Madrigal VN, Leone TA, et al: Primary Intensivists and Nurses for Long-Stay Patients: A Survey of Practices and Perceptions at Academic PICUs (1). First, some background information to review about the definition of CCI/CCC, its scope and scale, and what parents need. In the July 2021 issue of PCCM we read about a survey of 110 parents of children with CCC or CCI that emphasized the unique needs throughout their medical journey (2,3). In the January 2023 issue we read about work using the Virtual Pediatric Systems Database (2017–2019) in over 290,000 index cases to test the reproducibility of various definitions and techniques to identify patients with CCC/CCI (4). In the February 2023 issue the International Pediatric Chronic Critical Illness Collaborative presented a scoping review of 67 studies (published up to March 2021), with 12 reporting defining features of CCI that could be used in epidemiology and outcomes research (5). The accompanying editorial highlighted the need for collaboration between all stakeholders involved in CCI/CCC management, including children and families, critical care providers, general pediatricians, hospital administrators, and policymakers (6). Now, in this issue of PCCM, my first Editor’s Choice article reports a survey about medical supervision and organizational management of CCI/CCC cases; the respondents are physicians and nurses at the 72 U.S. centers with Pediatric Critical Care Fellowship programs (1). The response rate was very good. Please read what these academic centers are doing, and their experience–both positive and negative. Regarding the potential negative effects, also read the accompanying editorial that discusses the reality of “balancing continuity for long-stay patients and wellness for clinicians” (7). WHAT SHOULD WE KNOW ABOUT PULSE OXIMETRY AND RACE IN THE PICU POPULATION Savorgnan F, Hassan A, Borges N, et al: Pulse Oximetry and Arterial Saturation Difference in Pediatric COVID-19 patients: Retrospective Analysis by Race (8). My second Editor’s Choice article highlights an aspect of clinical measurement that we must now recognize as being highly important. There is a significant amount of literature in adult COVID-19 cases that shows a difference between simultaneous measurement of co-oximetry arterial oxygen-hemoglobin saturation (Sao2) and pulse oximetry oxygen-hemoglobin saturation (Spo2) when comparing data from Black versus White populations (9). In response to these publications, in November 2022, the U.S. Food and Drug Administration (FDA) issued a commentary about the COVID-19 pulse oximeter studies after its “safety communication meeting” (see https://www.fda.gov/medical-devices/safety-communications/pulse-oximeter-accuracy-and-limitations-fda-safety-communication). Regarding these clinical measurements we should acknowledge that: 1) the accepted standard used in FDA approval of new oximetry devices is a difference between simultaneous Sao2 and Spo2 values being within a tolerance of ± 4% for Spo2 above 80%, i.e., a Spo2 value of 90% may represent a Sao2 value of 86% to 94%; 2) the FDA requires industry to evaluate pulse oximeters in a test population that is representative of the U.S. population, and comprises 15% Black. The new report in PCCM looks at simultaneous Sao2 and Spo2 values in over 2,700 pediatric patients with COVID-19, of whom 61% were Black, and compared Spo2 measurement bias in Black versus White patients. Both the primary article and the accompanying editorial are essential reading material (8,10). The ramifications of these findings and discussion are serious, and particularly troubling. Our response at PCCM is that we now require some form of sensitivity analysis when Spo2 is used to risk-stratify patients in our research. For example, think about what we should now know and consider as a limitation when reading a report that imputes arterial partial pressure of oxygen to fractional inspired oxygen (Fio2) ratio from Spo2/Fio2 values. The same limitation applies to replacing the “oxygenation index” with the “oxygen saturation index” (11–13), which I challenge our researchers to now resolve. WHAT CAN WE LEARN FROM ELECTROPHYSIOLOGIC MONITORING OF TONIC DIAPHRAGMATIC ACTIVITY DURING THE EXPIRATION PHASE OF BREATHING? Plante V, Poirier C, Guay H, et al: Elevated Diaphragmatic Tonic Activity in PICU Patients: Age-Specific Definitions, Prevalence, and Association (14). My third Editor’s Choice article takes us back to some welcomed physiology. Over the last 5 years PCCM has published seven research articles and six editorials/commentaries about the diaphragm. A recent focus is the use of transcutaneous electrophysiologic monitoring of diaphragm activity (15,16). We now have a detailed study that describes age-specific, population normal values for elevated diaphragmatic tonic electrical activity (Edi). The authors then use this information to assess the prevalence of high tonic Edi during the acute phase of illness in 200 intubated patients and 222 patients supported with noninvasive ventilation. The authors also provide a useful focus on bronchiolitis. The accompanying editorial takes us through the underlying respiratory physiology of work of breathing and addresses the question of whether the Edi signal is helpful to PICU clinicians in guiding ventilator strategies, particularly during the use of positive end-expiratory pressure (17). “PCCM CONNECTIONS” FOR READERS This month’s special topic for educational review is management of severe illness in resource-limited settings. Start with this month’s Special Article about operationalizing appropriate sepsis definitions in children, worldwide, with an emphasis on low- and middle-income (LMIC) settings (18); the article comes from the Society of Critical Care Medicine Pediatric Sepsis Definition Taskforce (19,20). Follow this introduction to sepsis practice in LMIC settings by reviewing two reports from PCCM 2021 about severity of illness. First, an article by the Kenya-Seattle collaborative that examined feasibility of family-assisted severity of illness monitoring for hospitalized children in the Kenyatta National Hospital, Nairobi, Kenya (21). Second, an article from South Africa that evaluated the Pediatric Index of Mortality 3 score in this region (22,23). Next, from PCCM 2022, re-look at two reports about management of shock in LMIC settings: Uganda and Kenya, in the era after the fluid expansion as supportive therapy (Fluid Expansion as Supportive Therapy) trial (24,25); and Malawi, with a report about cardiac dysfunction in children with severe febrile illness (26,27). Last, complete your educational review of severe illness in LMIC settings by returning to this month’s issue of PCCM. Here, you can learn about the first PICU in Malawi and the authors’ experience of 531 admissions, with 28% mortality (28,29). Finally, another highlight for me in the narrative essay series is the article entitled “She Wept” (30).