HFV has been demonstrated to be a safe and effective way to ventilate and oxygenate patients, both short- and long-term, when used by experienced practitioners. It has carved out a niche in the specific management of respiratory problems in children and neonates; however, as understanding of the variables that independently contribute to VILI evolves, it is becoming clear that this mode of ventilation may be suited to the goals of lung protection. In addition, it is accepted also that initial assessment of HFV as a lung-protective strategy has failed to take into consideration significant variables that have been shown to be important in animal studies. This may have caused this mode of ventilation to be over looked as a possible strategy in the management of patients with severe lung disease. A number of trials are underway using ventilatory approaches based on current concepts of VILI, including improved CMV strategies. It is hoped that the results of these studies will identify the future role for HFV in the clinical setting.