High-tech components such as drug therapy, mechanical ventilation, renal replacement therapy and many kinds of monitoring characterise day-to-day care in the intensive care unit (ICU). They yield the impression of safety and control, to reassure patients’ uncertainties, pain, bereavement and agony. Naturally, doctors and nurses give priority to maintenance of the clinical aspects. However, the primary focus on the treatment of clinical symptoms may impede the understanding of the spiritual needs of patients. A life-threatening disease may lead to an existential crisis with patients and their relatives. Consequently, questions related to their beliefs and worldview arise. Spiritual caregivers can play a complementary role in meeting spiritual needs within whole patient care. However, structured and protocolled spiritual care is scarce. In this review we highlight a more or less unexplored area of ICU patient care and intend to encourage spiritual caregivers to get increasingly involved in routine ICU care. © 2017, Netherlands Society of Intensive Care. All rights reserved.