Abstract Purpose of Review We conducted a literature survey and meta-analysis to assess, in Mediterranean forests impacted by drought, the role of xylem functional traits as indicators of tree health, and their potential to adjust over a range of climatic conditions to support tree performance and survival. We aimed also to depict the geographic variability of xylem functional traits among Mediterranean forest trees as a tool for regional scale-oriented vulnerability assessment. Recent Findings Associations were investigated among xylem functional traits, hydraulic safety, and whole plant drought resistance for tree species in Mediterranean-type climates. Variable data were available from a number of study cases of Mediterranean forest communities impacted by intense drought, wherein tree growth and xylem functional traits were investigated along with tree decline and dieback episodes. Variable data were available from a number of studies that analyzed xylem trait adjustments to climatic conditions at different temporal scales. Summary We observed differing growth patterns and xylem conduit area responses in healthy and unhealthy trees and we sketched hydraulic strategies that may fit observed patterns. Overall, a clear role of xylem conduit size as stand-alone tree health indicator did not emerge. We showed that xylem traits may adjust along different temporal scales and may support the performance and health of Mediterranean tree species over a range of climatic conditions. We outlined substantial geographic variability in xylem traits across the Mediterranean region, suggesting patchy responses to increasing drought. Knowledge gaps and needed lines of research are highlighted.