Objective To investigate the clinical effects and safety of high-frequency chest wall oscillation (HFCWO) in the elderly bedridden patients. Methods A retrospective analysis was conducted of 82 elderly bedridden patients admitted to Xijing Hospital of Air Force Medical University from October 2019 to October 2020. According to intervention, the patients were divided into HFCWO group (n=39) and CPT group (n=43). Comparisons were made between the pre- and post-intervention breathlessness, cough and sputum scale (BCSS), 24h sputum volume, pulmonary ventilation function and incidence of pulmonary infection (PI). The two groups were observed in heart rate (HR), systolic blood pressure (SBP), respiratory rate (RR) and pulse oxygen saturation (SPO₂) 10 min before, during, and 10 min after the initial HFCWO treatment. SPSS statistics 23.0 was used for data analysis. Depending on data type, t-test, χ²test, rank-sum test were performed for comparison between the two groups. Results The HFCWO group received 1 118 times of HFCWO treatment, of which 1 003 (89.7%) times were well tolerated and 64 (5.7%) times were not. There were no significant differences in HR, SBP, RR and SPO₂ 10 min before, during, 10 min after the HFCWO treatment (P>0.05 for all). After treatment, BCSS of the HFCWO group were significantly lower than those of the CPT group [3.0 (2.0,3.0) vs 4.0 (3.0,5.0), P<0.001]. The sputum volume also decreased significantly on the fifth and seventh day [(28.9±3.9)vs(33.2±3.3)ml, (19.9±3.4) vs (27.2.9±3.3) ml; P<0.001]. Compared with the CPT group, pulmonary ventilation function in HFCWO group was significantly improved with forced vital capacity (FVC) [(2.150±0.134) vs (2.067±0.185) L, P=0.021] and forced expiratory volume in 1 second (FEV1) [(1.404±0.063) vs (1.348±0.105) L, P=0.004]. There was no significant difference in the PI rate between the two groups (P>0.05). Conclusion HFCWO is safe and well tolerated in elderly bedridden patients, and it can significantly improve dyspnea, cough and sputum, promote the discharge of bronchial secretions and improve the pulmonary ventilation, and to a certain extent, reduce the pulmonary infection.