Global concern arose from the threat of the H1N1 influenza pandemic. Despite the potential virulence of the illness, little is actually known about how severe disease develops or what treatments may confer benefit to critically ill patients. Even less is known about how to conduct clinical research in the setting of an evolving pandemic. Severe H1N1 infection primarily affects young and often previously healthy individuals. Early reports supported that aboriginal populations in Canada and Australia, obese individuals and women, especially pregnant women, appear to have a predilection for severe disease. Unlike the pandemic of 1918, the availability today of antiviral agents, antibiotics for secondary infection, and ICU supportive care interventions holds promise that the majority of patients with severe illness can be saved. The burden of severe H1N1 disease falls prominently on the ICU [8, 38] . Consequently, the opportunity to learn about treatments for severe H1N1 disease and how to conduct pandemic critical care research rests within the ICU community.