Intensive care support of patients with severe respiratory failure has improved over recent years and with improved methods of ventilation fewer of these patients now die. However despite these improvements, a significant number of patients still die with acute respiratory failure. The outbreak of pandemic (H1N1) 2009 influenza presented NSW intensive care units with many critically ill patients with severe acute respiratory failure. Three case studies and summary data illustrate the impact of these patients on intensive care units services in Australia and New Zealand.