AbstractObjectiveHigh frequency percussive ventilation (HFPV) is used in acute respiratory failure, but is poorly described in pediatrics. We aimed to describe the clinical characteristics, ventilator settings, and outcomes of a large pediatric cohort, and to determine predictors of who would benefit from HFPV.HypothesisGas exchange 2 h after HFPV initiation predicts success.DesignSingle center retrospective cohort study testing association between gas exchange 2 h after HFPV initiation with success, defined a priori.PatientsIntubated children on HFPV for ≥2 h from 2012 to 2018.MethodsWe described indications, ventilator settings, and gas exchange immediately before, 2 h after, and at termination of HFPV. Univariate and multivariate regression tested association of oxygenation and ventilation after HFPV initiation with success. Areas under the receiver operating characteristic (AUROC) curve and adjusted odds ratios (aORs) were computed.ResultsWe performed 237 courses of HFPV in 193 children (22% non‐survivors), of which 162 (68%) were successful. In univariate analysis, pH (AUROC, 0.65) and PCO2 (AUROC, 0.66) 2 h after HFPV predicted success. In multivariate analysis, pH (aOR: 1.67 per 1 SD; 95% confidence interval [CI]: 1.19–2.35), PCO2 (aOR: 0.49 per 1 SD; 95% CI: 0.31–0.79), and oxygenation index (aOR: 0.66 per 1 SD; 95% CI: 0.44–0.97) 2 h after HFPV initiation were associated with success.ConclusionWe describe the largest cohort of HFPV to date, with detailed description of indications and settings. Gas exchange after 2 h of HFPV was independently associated with success.