Critical care treatment of COVID-19 patients comprises a broad spectrum of intensive care medicine. This paper was written after searching for newest research papers and meta-analyses containing most updated data about modalities of intensive care and care of criticaly ill COVID-19 patients. First of all it includes pathophysiology and types of COVID pneumonias for better understanding ventiltation strategies. Severe pneumonia with ARDS will require non-invasive respiratory support (HFNC and NIV) or most likely invasive mechanical ventilation. While talking about non-invasive respiratory support more attention is added to HFNC although both tehniques NIV and HFNC have their advantages and disadvantages. Invasive mechanical ventilation must be clearly tapered and titrated to patients considering their inflammatory condition in the lungs. Although at the beginning it was thought that COVID-19 ARDS was the same as ARDS of any other etiology, not all patients are equal and they present a very heterogeneic group of patients with a special consideration on treatment of L and H types of pneumonias. Intubation decision, although seemed simple, must be made proactively so to prevent patient self-inflicted lung injury (P-SILI). Except lung protective ventilation strategies, it is important to prone position the patients throughout most of the day considering it benefits a very significant survival improvement. In latest meta-analyses application of antiviral medication such as remdesivire does not bring promising results, but application of corticosteroids along with remdesivire shows a significant mortality reduction. Also it is not the same whether dexamethasone or metilprednisolone is applied since the last one penetrates the lungs more efficiently and hence has an even lower mortality rate then dexamethasone. Also application of JAK inhibitors and IL-6 receptor antagonists shows significant reduction in mortality and progression to mechanical ventilation. Considering COVID-19 is a prothrombogenic disease a profilactic dose of anticoagulation medication is recommended. Cardiac and renal function monitoring is needed since they are the second two most affected organs in COVID-19, besides pneumonia. Every patient must be properly analgosedated, while application of neuromuscular blockade is limited. For the most severe, but younger patients ECMO with it's „ultra lung-protective“ ventilation is reserved.