Children admitted to the pediatric intensive care unit frequently require invasive mechanical ventilation, a critical intervention central to managing severe respiratory failure and supporting gas exchange. This Year in Review article highlights notable articles on pediatric mechanical ventilation published between 2023 and 2024, curated for clinicians and researchers dedicated to optimizing respiratory care. Key topics include lung-protective ventilation strategies, ventilator liberation practices, assessments of pulmonary function, cardiopulmonary interactions, and the impact of quality improvement initiatives on safety and outcomes, emphasizing the role of structured interventions to reduce preventable adverse events. Together, these studies underscore the complexity of pediatric mechanical ventilation and the importance of individualized, evidence-based strategies in advancing respiratory care for critically ill children.