The COVID-19 pandemic has resulted in unprecedented numbers of critically ill patients. Critical care providers have been challenged to increase the capacity for critical care, prevent the spread of syndrome coronavirus 2 in hospitals, determine the optimal treatment approaches for patients with critical COVID-19, and to design and implement systems for fair allocation of scarce life-saving resources when capacity is exhausted. The global burden of COVID-19 highlighted disparities, across geographic regions and among minority patient populations. Faced with a novel pathogen, critical care providers grappled with the extent to which conventional supportive critical care practices should be followed versus adapted to treat patients with COVID-19. Fiercely debated practices included the use of awake prone positioning, the timing of intubation, and optimal approach to sedation. Advances in clinical trial design were necessary to rapidly identify appropriate therapeutics for the critically ill patient with COVID-19. In this article, we review the epidemiology, outcomes, and treatments for the critically ill patient with COVID-19.