Background　As a new kind of ventilatory mode, high-frequency oscillatory ventilation(HFOV) is characterized by the rapid delivery of small tidal volumes cycling and high mean airway pressure. It has been successfully used in adults with the acute respiratory distress syndrome(ARDS). It has been shown that HFOV has advantages over conventional mechanical ventilation(CMV) in improving oxygenation and reducing the incidence of ventilator associated lung injury(VILI). However, the effect of HFOV on mortality still needs to be characterized.　Objective　To summarize the trials evaluating HFOV in adults with ARDS and reveal both the strengths and weaknesses of HFOV.　Content　HFOV is associated with significant improvement in oxygenation and prevention of VILI, however, not associated with reduction of mortality. Further researches are needed to identify optimal patient selection, timing, ventilator settings, and the role of combining HFOV with other interventions.　Trend　Further researches and explorations are needed to define the role of HFOV in adult ARDS.