Pediatric surgical diseases can cause pathophysiologic and anatomic alterations to the respiratory system that place the patient at risk for respiratory failure. The goal of this chapter is to introduce the reader to the range of respiratory support devices and the indication for their use and highlight opportunities to liberate the patient from these therapies as their condition improves. An understanding of the anatomy and physiology is key to recognizing issues that may arise preoperatively or postoperatively and feeling comfortable addressing them. In this chapter we will review the anatomy and physiology of the respiratory system in children, the causes and risk factors for hypoxemic and hypercapnic respiratory failure, and the applied physiology of mechanical ventilation. We will review the spectrum of respiratory support devices commonly used in the pediatric population ranging from supplemental oxygen to noninvasive and invasive mechanical ventilation, along with the common modes used in the intensive care unit, and provide guidance on their use. We will additionally discuss the management of special populations at risk for preoperative and/or postoperative respiratory failure.