Mechanical ventilation has become a cornerstone of management of critically ill children in the intensive care unit. Indications for mechanical ventilation are numerous and strategies to effectively support patients yet minimize iatrogenic injury are imperative. This review aims to provide a broad overview of pediatric mechanical ventilation. A discussion of core principles of respiratory physiology integral to mechanical ventilation and an overview of commonly used ventilators and ventilator modes will be provided. Focus will then turn to general goals of mechanical ventilation with emphasis on pathophysiology. The latter half of the review will examine general indications for mechanical ventilation and mechanical ventilation in different disease states, including restrictive lung disease, obstructive lung disease, congenital heart disease, and shock. Finally, indications for and methods of weaning from mechanical ventilation will be discussed.