Does high-frequency oscillatory ventilation (HFOV) improve survival in ARDS? The OSCILLATE trial evaluated the efficacy of HFOV compared with conventional lung-protective ventilation in patients with moderate-to-severe acute respiratory distress syndrome (ARDS). This multicenter randomized controlled trial, conducted across 39 ICUs in five countries, planned to enrol 1200 patients but was stopped early after 548 patients were randomized due to safety concerns. The study found that HFOV increased in-hospital mortality. Besides, patients in the HFOV group required higher doses of vasoactive drugs, suggesting hemodynamic compromise as a potential cause of harm. These findings indicate that early HFOV does not reduce and may increase mortality in ARDS, and should not be routinely used as a first-line ventilation strategy.