In this vein, the findings by Wilkinson and colleagues4 in this issue of CHEST (see page 1425) are intriguing. These investigators show that levels of multiple neutrophil-derived proteases are elevated in people with VAP. Pathophysiologically, this is not surprising given the extent of inflammation that can ensue in any form of pneumonia. Most interestingly, human neutrophil elastase appeared to have potential diagnostic value, with an area under the receiver operating curve of 0.87. This was calculated relying on the results of lower airway cultures for comparison, and, as noted, there truly is no gold standard for VAP. Therefore, although far from perfect, this measurement may help us to determine more accurately who does (or does not) have a lower airway infection, an effort critical to improving patient outcomes and to preventing antibiotic abuse.