Mechanical ventilation is a crucial skill to master in critically ill patients. Over the last two decades, several advances have emerged in our understanding of best mechanical ventilation practices in the intensive care unit (ICU). The search continues for novel modes of ventilation that can achieve better physiological and clinical outcomes while minimizing the negative impacts of positive pressure ventilation on critically ill patients. Flow controlled ventilation (FCV) is one of the newest advances in mechanical ventilation modes. While most conventional modes focus on controlling pressure or volume during inspiration with a passive expiratory phase, FCV has taken a different approach. FCV provides constant flow throughout the respiratory cycle including both the inspiratory and expiratory phases. This has the potential advantage of improving the efficiency and homogeneity of alveolar gas exchange resulting in better lung recruitment. It may also result in less dissipated energy thus minimizing lung injury to the lungs. While most data on FCV in critically ill patients come from few case reports and small studies, this novel mode may have the potential of being adopted in several situations in the ICU while larger studies are underway. In this chapter, the FCV current state of evidence will be reviewed in ARDS, obesity, upper airway stenosis and other special situations in the ICU.