Patients with tuberculosis admitted to the intensive care unit represent a small (1–3%) yet significant subset of the global tuberculosis burden. This article reviews current evidence supporting the diagnosis and management of patients with tuberculosis admitted to an intensive care unit from a combination of cohort studies and national and international tuberculosis guidelines. This review considers admission, diagnosis, mechanical ventilation, infection control, treatment and prognosis of patients with tuberculosis admitted to an intensive care unit. It highlights both diagnostic and management challenges and areas where ambiguity remains and further evidence is required.