A few decades ago, the use of pulmonary artery catheters was widespread in ICUs. Today, such catheters are infrequently used, mainly because of controlled, prospective data that failed to show improvements in patient outcomes. Considerable time elapsed for this transition in practice to take place. Let us hope that we have learned from this lesson, and that patient outcomes from therapeutic bronchoscopic procedures are subjected to close scrutiny. In my opinion, such procedures should not be performed outside of centers of excellence, and such centers should enroll their patients in prospective controlled clinical trials.