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Objective: To quantify the current practice patterns of mechanical ventilation for respiratory failure in pediatric patients., Design: Mail survey using 2 hypothetical case studies sent to pediatric critical care physicians., Measurements and Main Results: The required arterial blood gas (ABG) on conventional mechanical ventilation (CMV) is pH = 7.25 to 7.29, PO2 = 50 to 59 torr, O2 saturation = 0.85 to 0.89. Most of our survey participants will treat a patient failing conventional mechanical ventilation in their pediatric intensive care units (PICUs) with inverse ratio ventilation (IRV) (95%) and with high-frequency oscillatory ventilation (HFOV) (92%)., Conclusion: Most of the surveyed pediatric critical care physicians practice permissive hypercapnia in the treatment of their patients who receive ventilatory assistance. More than 90% of surveyed pediatric critical care physicians are presently using inverse ratio ventilation and high-frequency oscillatory ventilation. These data suggest that these innovative modes of therapy are already accepted as part of the standard therapeutic spectrum by the surveyed group of physicians.