Paediatric acute respiratory distress syndrome (PARDS) is a common, severe manifestation of direct or indirect lung injury in children. Management focuses on the careful implementation of lung protective strategies with high-frequency oscillatory ventilation (HFOV) and prone positioning often deployed in the most severe cases. As such, we read the Prone positioning and high-frequency oscillatory ventilation in early paediatric acute respiratory distress syndrome (PROSpect) trial by Martha A Q Cu