The book begins with two discussions of diagnostic strategies for VAP, as presented by Jean-Yves Fagon and Jean Chastre (presumably, the European experience) and Michael S. Niederman (presumably, the North American counterpart). The editors clearly chose their authors wisely, since one could hardly imagine two more opposite viewpoints. The first advocates invasive, quantitative culture techniques, while the latter maintains that a “clinical and empiric approach” makes better sense. Both chapters marshal considerable supporting evidence from the literature, but neither can cite definitive randomized controlled trials providing unequivocal evidence of the superiority of either approach. The reader is still left with the essential controversy unresolved. While the empiric view may be easier and more convenient, a diagnosis that relies on “a new or progressive infiltrate with at least 2 of the following 3 criteria: fever, purulent sputum, or leukocytosis” can hardly be specific when other common intensive care syndromes can, and often do, duplicate these findings. On the other hand, quantitative culture techniques may lack sensitivity, particularly in the case of early infection, and may be prone to false-negative results, especially when performed after antibiotic treatment already has been started.