Ramnarayan P, et al. - In this multi-centre pilot randomised controlled trial (RCT), researchers compared high-flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) in paediatric critical care in order to assess the feasibility, and inform the design and conduct, of a future large pragmatic RCT. Two groups of patients were formed: Group A [step-up non-invasive respiratory support (NRS)] or Group B (step-down NRS). The first-line mode of NRS was either CPAP or HFNC. In both step-up and step-down NRS patients, the feasibility of performing a large national RCT of non-invasive respiratory support in the paediatric critical care setting was confirmed after minor changes to consent procedures and treatment algorithms.