This study raises some relevant concerns. First, because of the anatomical constraints of the thoracic cage, TUS can at best explore about 70% of the pleural surface, and even in zones amenable to TUS examination, only lesions adherent to the pleural surface may be visualized. This partly explains the overall rather low sensitivity of TUS in the current study. In actuality, as also stated by the authors, because of the positive pressure generated by mechanical ventilation, the foci of bronchopneumonia in VAP tend to spread to the periphery; but, again, they are detectable by TUS only when adherent to the pleural surface. This could in turn result in a lower sensitivity of TUS in VAP as compared with community-acquired pneumonia. Sonographic patterns of subpleural abnormal aeration are frequently observed in patients mechanically ventilated for various diseases. Other conditions reducing lung aeration may be alternatively or concomitantly present in critically ill, mechanically ventilated patients, such as elevated diaphragm and atelectasis, atypical pulmonary edema, pulmonary hemorrhage, thromboembolism, drug reaction, and ARDS. All these conditions share common sonographic patterns, and each picture is further compounded by comorbidities, so that TUS features cannot be considered disease-specific. In addition, the authors lay particular emphasis on the results concerning “linear/arborescent bronchograms.” However, it should be stressed that no study or meta-analysis has so far demonstrated that such hyperechoic images do really correspond to the CT imaging finding of air bronchogram. Instead, we have shown that such images can also be detected in lung neoplasm masses (Fig 1). Moreover, according to our experience, it seems difficult to obtain reliable and repeatable results by synchronizing a TUS scan with mechanically induced inspiration, particularly when different operators are involved.