High-frequency oscillatory ventilation (HFOV) has been proved to decrease the incidence of volutrauma and improve oxygenation and ventilation in severe pulmonary diseases by many investigators with animal studies and clinical reports, particularly in prematurities with severe respiratory distress syndrome. Patients with intractable respiratory failure or air-leak syndrome may be rescued by HFOV. During HFOV small volume, less than dead space, is delivered at high frequencies. Both inspiration and expiration are active. Oxygenation is mainly maintained by mean airway pressure to achieve optimal lung volume. Carbon dioxide elimination is mainly controlled by delivered volume. Mean airway pressure, fraction of inspiratory oxygen and amplitude are the only three items that need frequent adjustments after initial settings. The first two items determine the oxygenation and the last one determines ventilation. Careful monitoring of conditions the patients, discontinuous learning and cooperation of all coworkers are important to use the new therapy. Further studies with long-term follow-up are important to assess its appropriate role in different treatment methods and different degrees of respiratory diseases.