It was unclear from the article if the length of duration was shorter in the ETA group due to death foreshortening the planned time frame or if a short duration was intentional, thus, leading to death from inadequate dosing, which is a possible confounding factor of the difference in outcomes between the two groups. Their hypothesized protocol involved holding off on the initiation of antibiotics with a negative ETA. A delay in antibiotic administration is known to be associated with mortality, so empirical antibiotics in suspected VAP are recommended prior to any culture results.2 With the risk of mortality outweighing the benefit of expediting deescalation of antimicrobials, most physicians will not change this practice. Those treated based on guidelines would be expected to have a shorter duration as the days on empirical therapy could be factored into the overall planned duration, while the ETA group will need a longer antibiotic duration with drug escalation. The authors also did not state clearly if the guideline-treated group had stopped treatment with antimicrobials within 48 to 72 h based on negative BAL or if the duration often deviated from the 7- to 8-day minimum or 10-day Pseudomonas recommended treatment to longer regimens based on clinician preference.