Industrial biotechnology has a potential to tackle harmful CO2 emissions and turn CO2 into a valuable commodity. However, a major technical obstacle in gas fermentations is the limited gas mass transfer rate. Increasing system pressure is a way to increase the driving force for mass transfer. This review presents critical aspects of gas fermentation at elevated pressure, with a specific focus on results obtained at 5-10 bar. While a solid foundation for high pressure fermentations has already been laid in the past, mainly to enhance oxygen transfer rates, it can be concluded that fermentations at moderately elevated pressures using gases such as CO2, CH4, CO, H2, O2 are still underexplored. Microbial growth rates and product formation can be improved at higher pressures, but in general, titers and productivities need to be increased to allow a further industrialization. Hence, more systematic investigations and techno-economic assessments are required.