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This report presents a comprehensive study of gas exchange, acid-base and electrolyte homeostasis and cerebral and hemodynamic disturbances in 302 critically ill patients with acute pneumonia. Twenty-six children were classified as severely ill, 176 as preagonal and 100 as agonal. Comparative statistical analysis showed that, as a terminal state develops in young children, disturbances of gas exchange, acid-base and electrolyte homeostasis and cerebral and systemic hemodynamics follow a common pattern regardless of the form of pneumonia. Hemodynamic and acid-base disturbances underlie these disorders and determine disease severity, course and outcome. The parallel, phased changes in acid-base balance and central and cerebral hemodynamics in patients with severe, preagonal and agonal pneumonia, together with the lower bicarbonate capacity of blood in young children, formed the basis of the proposed classification of acute respiratory and cardiac failure in young children with pneumonia.