Lymphatic dysfunction in critical illness is complex. Primary complex lymphatic anomalies can lead to profound organ dysfunction, particularly respiratory failure and shock. Critical illness, the complications of critical illness, and the procedures and therapies used to treat critical illness, can lead to secondary lymphatic dysfunction. This is most often seen with congenital and acquired cardiovascular disease and respiratory disease. It can be challenging to ascertain whether lymphatic failure is the cause or the effect of another organ dysfunction and vice versa. This article outlines management principles for critically ill patients with lymphatic failure with focus on care of the patient after lymphatic embolization procedure.