We read with great interest the study published by Zagli et al1 in a recent issue of CHEST (December 2014). In spite of originality and new insights concerning diagnosis of ventilator-associated pneumonia (VAP), some issues must be considered. First, seven Candida albicans microbiologically confirmed VAP cases is quite an unusual incidence for this pathogen. Diagnosis of Candida pneumonia should be abandoned in ICU setting when immunocompetent subjects are considered.2 Moreover, fungal airway colonization is a frequent finding in patients submitted to mechanical ventilation, and a Candida VAP diagnosis can only be firmly established based on histologic proof. Currently, some discrepancies are found in VAP diagnosis made by lung ultrasonography. Although wide exclusion criteria permitted a refinement of study population (lowering external applicability), the inclusion of trauma patients can be concealing consolidations not related to pneumonia, especially in patients with pulmonary contusion.3 Although based on consensus recommendations, the sonographic pneumonia diagnostic criteria are still controversial. As a matter of fact, it is level C quality of evidence (ie, “any estimate of effect or accuracy is very uncertain”).4 An interstitial pattern (B lines) does not exclude an infectious cause for lung damage—a corollary of radiographic infiltrates presented in the formal VAP diagnosis—and it was not clarified in the present study. Thus, a model of lung ultrasound diagnosis based in a comprehensive score, as previously described,5 should be a more promising tool.