Aims & Objectives: to describe contemporary invasive mechanical ventilation (IMV) practices in children admitted to Latin American PICUs with acute respiratory failure (ARF). Methods: Retrospective analysis within LARed Network ARF Registry. We analyzed all children who were prescribed IMV between May 2017 and October 2019. Data described as median (IQR) or frequencies, adjusted by mixed logistic regression model. Results: Of the 5397 patients, 1334 (25.2%) received IMV for 121 h (70-197). Age 5mo (2-14), 61% male, 38% comorbidities. Diagnosis: Bronchiolitis 55% (62% RSV); Pneumonia 34%; pediatric acute respiratory distress syndrome (pARDS) 25%, Sepsis, 24%. Mode: Assisted controlled (AC) (53% Pressure; 15% Volume), Dual mode (17%), Synchronized Intermittent Mandatory ventilation (13%). Maximal settings: positive end-expiratory pressure: 7 cmH2O (6,8), tidal volume:8ml/kg (4.2,14.2), Peak inspiratory pressure (PIP): 26 cmH2O (22,29), plateau pressure: 25 cmH2O (20,28), MAP: 13 cmH2O (11,15). IMV related complications (41/1000 IMV days): withdrawal syndrome (55%), weaning failure (23%), ventilator-associated pneumonia (15%). IMV free days: 24 (20-27), PICU LOS: 9 days (6,13). Mortality: 4.2%, PICU acquired morbidity: 7.8%. pARDS was associated to: longer IMV (Days OR 1.07; 1.05-1.10), more IMV complications (OR 4.05; 2.82-5.82) and nosocomial infections (OR 3.08; 1.84-5.15), and more hypoxemia rescue therapies use (OR 9.16; 6.27-13.38). Conclusions: In this Latin American cohort, 1/4 of children with ARF needed IMV. AC was the predominant ventilation mode and RSV bronchiolitis the most common disease. The great variability detected on ventilator settings along with the rate of IMV-related complications shows plenty of room for quality improvement initiatives.