Respiratory research in the critically ill pediatric patient: why is it so difficult?

Pediatric clinicians strive to base their management decisions on best available evidence. In the quantitative research paradigm, the highest level of evidence is derived from a conclusive randomized controlled clinical trial (RCT). Currently, there are few adequately powered RCTs to support pediatric acute respiratory care, but this landscape is changing. We are all obligated to ensure the relevance of our research, to mentor junior investigators, and to support knowledge development in our field. This paper reviews the hurdles faced by clinical investigators in the field of pediatric critical care and offers suggestions for future clinical studies.