The methods of diagnosing VAP are debatable and there is no accepted 'gold standard'. No study has shown the superiority of a specific method. The methods proposed have different sensitivities and specificities (11). So, additional validation studies are needed. Other indications of the need for further studies of the non-bronchoscopically directed techniques are the absence of standardized diagnostic thresholds for quantitative cultures, and to develop cheaper, reliable and easy to use diagnostic method involving inexpensive easily available equipment.