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Conclusion Influenza 2009 H1N1 infection in three southeast European ICUs affected predominantly healthy young patients and was associated with rapid deterioration after hospital admission and severe respiratory and multiorgan failure. These emerging ICUs provided contemporary ICU services, resulting in case-fatality rate comparable to reports from well-established ICU settings. After the first cases of human influenza A H1N1 infection were observed in Mexico in April 2009 (1), the infection quickly spread to Europe, Asia, and both Americas, which is why the World Health Organization (WHO) declared level 6 pandemic alert on June 11, 2009 (2). Up to February 2010, influenza A H1N1 virus was confirmed in more than 212 countries and caused more than 15 000 deaths (3). Compared with seasonal influenza, pandemic 2009 H1N1 influenza A has affected a great number of young, previously healthy patients and caused significant health and economic burden even in developed countries. So far, several studies have reported their experience with critically ill patients with 2009 H1N1 influenza in North America, South America, Asia, Australia, and Europe (1,4-12). A few studies have so far reported on H1N1 patients' characteristics and outcome in low-income and developing countries with limited ICU resources (1,8-12), and none on that in the west Balkans. The ICUs in these countries are mainly run by physicians who lack formal ICU training. Furthermore, until only recently non-surgical critically ill patients in these ICUs had limited access to mechanical ventilation and other life support interventions. However, over the past five years, three university hospitals in Bosnia and Herzegovina and Serbia have established multidisciplinary medical ICUs and most of critically ill patients with H1N1 influenza A infection in the region were admitted to these units. The aim of this study was to describe characteristics and outcomes of mechanically ventilated adult patients with 2009 H1N1 influenza A infection treated in these ICUs.