Surgical stress in ARDS open-lung biopsy.

factors vary depending of the exposure to risk (ie, length of ventilation).8 Our opinion on antimicrobial prophylaxis for VAP has been clearly stated in a recent editorial,9 and a randomized clinical trial to assess the effect of single-dose antibiotic administration as prophylaxis for VAP is highly recommended. Unfortunately, such evidence is lacking. Dr. Schultz suggests not using antimicrobial prophylaxis for percutaneous tracheotomies. However, as indicated before, prophylaxis for surgical neck procedures in intubated patients with colonized tracheal mucosa has a level 1 evidence. Until such studies are available, the extremely high incidence of VAP in the first days after the procedure, the distribution of pathogens, and the low predictive value of tracheal aspirates prior to tracheostomy1 suggest that prescription of a single dose of an antipseudomonal agent prior to the percutaneous tracheotomy is the most pertinent policy.