The July 2023 issue of Pediatric Critical Care Medicine (PCCM) features articles on clinical variables in extracorporeal membrane oxygenation (ECMO) that may affect neurologic outcomes, unplanned extubations in cardiac intensive care units, and the role of biomarkers in sepsis risk stratification in low- to middle-income countries. The clinical investigations focus on pulmonary physiology, especially pediatric acute respiratory distress syndrome (PARDS) and adverse events related to intubation in patients who have received hematopoietic cell transplants. The PCCM trial this month highlights a promising novel hemodialysis device for infants, and the clinical investigations cover the effect of mechanical power on mortality in patients with PARDS, clinician-assigned functional outcome scores in critically ill children, and the use of empirical acyclovir in children with acute encephalitis. The cardiac intensive care articles are both interesting quality improvement initiatives, one focusing on implementation of a sedation-weaning protocol and the other focusing on limiting blood draws for patients. Lastly, a meta-analysis assesses the use of aortic peak flow velocity in predicting fluid responsiveness in mechanically ventilated patients.