Amongst the machines that help save lives in the intensive care unit (ICU) environment, aerosol drug delivery devices play a special role. Aerosolization can rapidly achieve high-effective local drug concentration at the site of action with minimal side effects for treating respiratory conditions such as reactive airways diseases [1]. The vast alveolar surface area (100 m 2 ) and pulmonary blood flow (entire cardiac output) provide an alternative avenue for effective systemic therapy as well [1]. However, effective aerosol therapy in ICU is affected by the complex interplay with other machines [invasive mechanical ventilation (IMV), non-invasive ventilation (NIV), high flow nasal cannula (HFNC)] as well as the patient factors [1]. Various aspects of aerosol therapy are covered extensively elsewhere [1]. We provide a summary of the aerosolized therapy in ICU.