This article reviews innovations in mechanical ventilation in three distinct areas: high-frequency ventilation, tracheal gas insufflation, and nitric oxide. In all three of these areas, a number of important articles affecting actual or potential use of each of the techniques has been published. In high-frequency oscillation, adult trials are being conducted for the first time; with tracheal gas insufflation, refinement of administration techniques is ongoing; and, with nitric oxide, randomized controlled trials show no effect of nitric oxide on outcome in acute respiratory distress syndrome.