We read with great interest the study performed by Paula Ramirez and colleagues. The study included 71 patients with ventilator-associated pneumonia (VAP) and the authors coined a new term called "gradual VAP". The result of this study indicated that an early antibiotic treatment for patients with gradual VAP was associated with an increased rate of early clinical response. Based on the results of previous studies and our observational data, we would like to make some comments. There is still a grey area between ventilator-associated tracheobronchitis (VAT) and VAP in clinical practice, resulting in a situation where ventilator-associated event (VAE) and infection-related ventilator-associated complication (IVAC) are proposed as alternative terms for epidemiologic purposes.

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