Given the physiology of critical illness, any missteps may increase the potential for life-threatening complications. This is in contrast to the operating room where difficult DL usually is overcome by bag-mask ventilation, and emergency equipment often is not necessary. However, even in the operating room, some may fail to perform appropriate safety checks of emergency equipment.15 Two recent studies address the importance of systematic preparation for ICU intubations. By incorporating protective factors described in their own studies, Jaber and colleagues16 instituted a 10-point intubation bundle during ICU intubations. This systematic approach decreased both severe hypoxemia and cardiovascular collapse; total life-threatening complications were reduced from 34% to 21% of intubations. That they reduced severe complications compared with their own previous data suggests that the improvements were due to the systematic approach rather than to a change to a physician more skillful in DL. In fact, the rates of difficult intubation, esophageal intubation, aspiration, and dental injury—complications of DL—did not change. Mayo and colleagues17 also deployed a highly structured ICU airway checklist in a medical ICU staffed by pulmonologists. During airway management in their hands, severe hypoxemia occurred in 14% of cases, and severe hypotension in 6% of cases. These complication rates rival those documented by anesthesiologists using the intubation bundle of Jaber and colleagues16 and are arguably better than those previously documented by anesthesiologists operating without an explicit structure.3,4 Taken together, these studies demonstrate that a systematic approach to ICU airway management results in improved patient safety. Importantly, a structured environment transcends medical specialty.