AbstractHigh‐frequency ventilators (HFV) use increased respiratory rates and decreased tidal volumes to achieve gas exchange similar to conventional mechanical ventilators (CMV). This reverses the relative importance of convection and diffusion to gas exchange. There are currently 3 major types of HFV. They differ from each other in how gas is delivered, how they work, and what physiological effects they have. Conclusions drawn using one type of HFV cannot necessarily be applied to the others. This review examines the different types of HFV as well as the studies that have been conducted using HFV. It stresses the role that HFV may play in the surgical intensive care unit. The one certain indication presently for HFV is in patients with a bronchopleural fistula. It may also be useful as an adjunct to endoscopy and in adult respiratory distress syndrome (ARDS). If the underlying lung disease cannot be reversed (i.e., end‐stage fibrotic ARDS), HFV has little to offer.