Prediction of Postoperative Lung Function in Patients With Lung Cancer

We thank Drs Myrianthefs and Baltopoulos for the data reported in their letter. They used the results of our recently published study in CHEST 1 to evaluate the different economic outcomes of patients in the ICU with ventilator-associated pneumonia (VAP) treated with IV colistin monotherapy or aerosolized plus IV (AS 1 IV) colistin therapy in a Greek hospital. They found that 7-day AS 1 IV colistin therapy is less expensive than 10-day IV colistin monotherapy. They also found that a considerable cost benefi t may occur as a result of fewer days under mechanical ventilation (MV) and shorter length of ICU stay. Of course, we agree with them that the use of AS 1 IV colistin therapy can be a costeffective strategy in patients with VAP, shortening the duration of therapy, MV, and ICU stay and achieving better clinical outcomes. Because our study was retrospective, a proper cost assessment was not completely reliable, especially in the absence of parameters whose prospective collection would have been important (ie, those related to nurse workload). Consequently, we preferred to not speculate on the cost-benefi t analysis. As the total length of hospitalization is the main cost driver, in our institution a considerable cost benefi t would also be expected as a result of fewer days under MV and shorter ICU length of stay. In conclusion, the cost-effectiveness of AS 1 IV colistin therapy for the management of VAP caused by multidrug-resistant gram-negative bacteria should be an important end point to be further investigated in multicenter prospective randomized clinical trials.