In this issue of Critical Care, Camporota and colleagues

[1] report interesting observations on the relationship between the initial gas exchange response to high-frequency oscillatory ventilation (HFOV) and clinical outcomes. HFOV seems ideally suited to protecting the lung during mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). By delivering very small tidal volumes and allowing higher mean airway pressures, HFOV can potentially minimize both volu-trauma and atelectrauma [2]. However, the recently pub-lished OSCILLATE (OSCillation in ARDS Treated Early) [3] and OSCAR (High-Frequency OSCillation in ARDS) [4] trials – both of which postdate the article by Camporota and colleagues – found that HFOV failed to reduce mortality. In particular, OSCILLATE raised questions of potential harm from HFOV. In the face o