Background: The main goal of mechanical ventilation is to support the respiratory drive. We are always transitioning through modes trying to find out the optimum for each ventilation purpose. Airway pressure release ventilation (APRV) is a promising mode with interesting achievements. We aimed from this study to explore the hidden potentials of APRV mode in comparison to our default ventilation mode in respiratory failure. Patients and methods: Randomized control trial, single blinded, included152 pediatric patients with age range 8 months to 17 years, who were admitted to intensive care units either in pediatrics, chest diseases, anesthesia or internal medicine departments, Zagazig University Hospitals, Egypt, with acute respiratory failure.76 were assigned to airway pressure release ventilation(APRV) mode and the other 76 patients were assigned to synchronized intermittent mandatory ventilation (SIMV) mode. In a period from April 2017 and Jun 2019. Results: No significant difference was found between APRV group and the SIMV group regarding the outcome. However, there was significant difference between the outcomes of the challenging cases labelled acute respiratory distress syndrome (ARDS) and pulmonary edema connected to APRV. Conclusion: APRV mode showed superiority in supporting ARDS and pulmonary edema patients, with no higher risk of mortality or complications.