Background: Airway pressure release ventilation (APRV) is a novel mode of ventilation. It is a form of bi-level assisted ventilation using continuous positive airway pressure (CPAP) with periodic decrease in pressure, either to a lower CPAP pressure or to atmospheric pressure. Aim of the work: to assess the ability of the APRV mode to improve the oxygenation and the mortality in cases with respiratory failure. Subjects and methods: A clinical trial was conducted in Pediatric intensive care unit in Zagazig university children's hospital included 76 patient. They were selected after failure of conventional mechanical ventilation, all patients were subjected to full history taking and full physical examination, routine labs and serial Chest X-rays, serial arterial blood gases and serial follow up of the ventilator parameters were observed. Results: APRV showed significant improvement in PaO2/FiO2 ratio and O2 saturation. Conclusion: APRV showed promising gateway to the cases of respiratory failure who failed their chances on conventional mechanical ventilation. Future studies are needed to compare both modes to assess the superior of one to another.