The concept of lung protective ventilation strategies is based on the limitation of the inspiratory pressure and the reduction of the tidal volume, in order to minimize the extent of breathing cycle-dependent damaging mechanisms from mechanical ventilation. This concept is coupled with various procedures for optimization of the end-expiratory lung volume in acute lung failure in order to improve the compromized oxygenation. In this situation high-frequency oscillatory ventilation (HFOV) has achieved a renaissance. Theoretically this procedure offers advantages which differentiates it from conventional ventilation procedures. The system allows the use of a constant higher mean airway pressure, a reduction of the peak pressure and the use of a tidal volume in the dead-space area. Very little data exist with respect to the application of this procedure in adult patients. For the clinical use of HFOV as a secondary procedure in adult patients suffering from acute lung failure it could be demonstrated that it is a safe and effective method of treatment. The effect of HFVO on the morbidity and mortality outcome, however, still needs to be characterized.