Diagnosis of Ventilator-Associated Pneumonia

In this issue of the Journal, Heyland et al., writing for the Canadian Critical Care Trials Group, report the results of a multicenter, randomized trial comparing the use of bronchoalveolar lavage and endotracheal aspiration for the diagnosis of ventilator-associated pneumonia.1 This study was part of a larger 2-by-2 factorial design also comparing empirical antimicrobial monotherapy (a carbapenem) and combination therapy (a carbapenem plus a fluoroquinolone). The authors conclude that bronchoalveolar lavage and endotracheal aspiration are associated with similar clinical outcomes and similar overall use of antibiotics. However, several important limitations of the study must be appreciated in order to place . . .