All critical care physicians should be adept at medical management of the airway, including basic and advanced life support measures. Proper head and neck positioning, use of non-definitive airways, and ability to oxygenate and ventilate the patient with bag-valve-mask should be part of the armamentarium of every critical care physician. Training, skill, and experience are fundamental to successful translaryngeal intubation. The nasal and oral routes of such intubation each have distinct advantages and disadvantages. Oral intubation is preferred for emergency establishment of a definitive airway in most situations. Skillful intubation technique and meticulous daily management of the upper airway should diminish the risk of complications of translaryngeal intubation.