Is fever control or improved survival the ‘risk factor’ for ventilator-associated pneumonia?

We read with interest the paper by Launey and colleagues [1] regarding the effect of fever control on the incidence of ventilator-associated pneumonia (VAP) in brain-injured patients. We commend the authors for addressing this relationship, given that fever and nosocomial infections are frequent in these patients. However, we have concerns regarding the interpretation of data. Firstly, independent risk factors for VAP, namely disease severity and lung contusion [2,3], are unevenly distributed between groups. In addition, other risk factors, such as chronic obstructive pulmonary disease (COPD) and ICU readmission [2,4], were not taken into account, suggesting any effect of fever control is likely subject to confounding. Secondly, mortality in the control group was higher (34% versus 23%), lowering the observation period if death occurred within 28 days. Thus, patients in the