Evaluation of patients prior to air travel.

the data (54% vs 90%, respectively) from a Spanish study.1 However, this type of humidification is not recommended in the Centers for Disease Control and Prevention guidelines.4 A semirecumbent body position was reported in 87% of patients, which is a lower percentage compared to that reported in the Spanish study.1 Noninvasive ventilation was used as a first-line treatment in 75% of the ICUs in our study. Antiseptic oral rinses were almost universally used. In our survey, the results of which were similar to those of the Spanish study,1 there was a 100% rate of administration of stress ulcer prophylaxis, although in our study proton pump inhibitors were the agents used most often, as opposed to antihistamine type 2 receptor blockers and sucralfate, which were the agents used most often in the Spanish survey.1 There was a 25% rate of reported clinical diagnosis of VAP, which is notoriously sensitive but not specific and is mostly used in small-sized hospitals, because bronchoscopic procedures were more available in largesized hospitals. Differently from the Spanish survey,1 there was a wide availability of quantitative cultures among the various participating ICUs, and only one ICU reported the use of qualitative cultures for the diagnosis of VAP. Our data highlight that there are local differences in the preventive and diagnostic strategies used for the management of patients with VAP. There are enormous possibilities for improving such strategies according to international guidelines. Regional surveys are of the utmost importance in discussing the recommendations from the published evidence and are especially useful in a regional setting, where resources are primarily allocated.