For decades, ventilator-associated pneumonia (VAP) has been thought to be the most important complication of intensive care medicine. A meta-analysis of studies published in the 1990s calculated the incidence of VAP, which is equivalent to 16.5 cases per 1,000 patient days. Attributable mortality due to VAP was estimated to be 20-40%, although the range in different studies was very broad. Healthcare costs realted to VAP seem to be remarkable, in particular with regard to multidrug-resistant pathogens. A controversial debate about the management of VAP occurred in the literature at the beginning of the century, but latterly the discussion has wound down. The latest VAP guidelines were published in 2005 by the American Thoracic Society/Infectious Diseases Society of America, and a consensus paper was published in in 2009; however, the number of VAP studies has decreased dramatically.