Airway management in the intensive care unit (ICU) is a challenging procedure and is frequently associated with life threatening complications. The incidence of difficult intubations ranges from 10% to 22%, depending on the setting and the patients in need of endotracheal intubation. Multiple attempts are often needed to secure the airway. Despite the high risk for patients in the ICU setting, the equipment for airway management such as capnometry or alternative devices is not always available. The novel technique of video laryngoscopy has been recently introduced into clinical practice in the operating room. First results from larger studies are very promising, suggesting these new devices to be helpful for successful intubation with fewer attempts in difficult intubation scenarios. At the same time, several reports show that successful use of video laryngoscopes in emergency situations need substantial practical training and expertise in airway management. The use of a protocol for airway management has been shown to decrease complications. Parts of this protocol are appropriate staffing, pre-oxygenation and strategies to avoid cardiovascular complications. In conclusion, high practical skill of airway management is needed in critically ill patients. Monitoring such as capnography and alternative equipment for securing the airway is not just mandatory in the operating room but also in the ICU.