Dr Walz notes a possible discrepancy in the number of intubation attempts between specialties with good reason. Multiple attempts are both (1) markers of difficulty and (2) direct causes of laryngeal edema that impair subsequent rescue and can hasten death. Accordingly, the relatively high rate of complications of direct laryngoscopy (DL) seen in Mayo and colleagues,2 including three or more attempts in 20% of patients, provokes some angst. Yet, the goal of intubation is not to limit DL but to preserve cardiopulmonary homeostasis. Severe hypoxemia occurred in 14% of their cohort and severe hypotension in 6%. Conversely, Simpson and colleagues3 reported very low rates of DL complications but severe hypoxemia in 22% and severe hypotension in 10% of patients managed by anesthesiologists. In this regard, the systematic, team-oriented approach of Mayo’s pulmonary group successfully limited important complications of ICU intubations.