Strengths of the study. This prospective study included consecutive patients selected with strict criteria including simplified CPIS and not on the attending physician suspicion, so reducing the selection bias. All the diagnostic procedures were done in the same sequence in a predefined time period and by the same investigators. As it appears, BBS and blind BAL can be used for the diagnosis of VAP. In this study performance of blind BAL was best, followed closely by BBS when compared with bronchoscopic BAL as a reference standard for the diagnosis of VAP. The imported balloon tipped pressure catheter used in this study for blind BAL costs INR 1600.00 whereas suction catheter made in India used for BBS costs less than INR 10.00. This huge cost difference is definitely a major consideration in the PICU of developing countries while investigating VAP.