The Best Way to Test for VAP Is to Get a BAL

In terms of the best way to test microbiologically for VAP, you should stick a catheter deep in the lungs and get a distal lung specimen. The American guidelines say the opposite. They do not preference distal lung sampling. Unless there's a contraindication to getting a BAL, like severe hypoxemia or some predisposition to bleeding based on platelets or INR, I think most people should get a BAL.