Study objectives. To report the results of treating respiratory syncytial virus-associated respiratory failure with high frequency oscillatory ventilation as rescue therapy. Design. Retrospective case series. Setting. A pediatric intensive care unit in a tertiary academic medical center. Patients or participants. Nineteen of 74 (26%) patients admitted to the pediatric intensive care unit over 3 years for respiratory syncytial virus respiratory tract infection developed respiratory failure. Eleven were treated with conventional ventilation only (group 1) and 8 were treated with high frequency oscillatory ventilation when conventional ventilation failed (group 2). Interventions. Medical records were reviewed to assess risk factors for severe disease, duration of mechanical ventilation and oxygen therapy, peak oxygenation index, length of stay, morbidities, and mortalities. Measurements and results. Group 2 had a longer duration of mechanical ventilation, oxygen therapy, length of stay, and a higher peak oxygenation index compared to group 1. Peak oxygenation index correlated positively with length of mechanical ventilation, length of oxygen therapy, and length of stay. Morbidities were minimal, and there were no mortalities. Conclusions. Rescue therapy with high frequency oscillatory ventilation was well-tolerated though the duration of therapy was prolonged. Further investigation of its role in pediatric respiratory syncytial virus-associated respiratory failure is needed.