Providing the right respiratory support is an essential skill, vital for anyone treating sick children. Recent advances in respiratory support include developments in both non-invasive and invasive ventilatory strategies. In
non-invasive ventilation, newer modalities are being developed, in an attempt to decrease the need for invasive ventilation. This include newer techniques like Heated humidified high-flow
nasal cannula (HHHFNC) and improvements in existing modes. The success of
Continuous positive airway pressure (CPAP) and other non-invasive modes depend to a large extent on choosing and maintaining a suitable interface. When it comes to invasive ventilation, recent advances are focussing on increasing automation, improving patient comfort and minimising
lung injury. Concepts like mechanical power are attempts at understanding the mechanisms of unintended
injuries resulting from respiratory support and newer monitoring methods like transpulmonary pressure, thoracic impedance tomography are attempts at measuring potential markers of
lung injury. Using the vast arrays of available ventilatory options judiciously, considering their advantages and drawbacks in every individual case will be the prime responsibility of clinicians in the future. Simultaneously, efforts have been made to identify potential drugs that can favourably modify the pathophysiology of
acute respiratory distress syndrome (ARDS). Unfortunately, though eagerly awaited, most
pharmaceutical agents tried in pediatric ARDS have not shown definite benefit. Pulmonary local
drug and gene therapy using
liquid ventilation strategies may revolutionize our future understanding and management of
lung diseases.