(page number not for citation purposes) [10, 11] . The relatively low mortality rate, the diversity of the study populations and the shorter duration of mechanical ventilation are factors that make large-scale randomized controlled trials in this population challenging to conduct. Two of the largest trials were stopped early due to slower than expected enrolment [12, 13] . While the use of surfactant in ARDS/ALI has not been previously systematically reviewed, its use in children with bronchiolitis has been [14] .