Our results agree with these considerations about the absence of a relationship between GRV and pulmonary aspiration. Nevertheless, we do not investigate the issue of pulmonary aspiration because this requires procedures such scintigraphy studies [28, 29], colored microspheres [24] or pepsin detection in tracheal aspirate [30], tests that were not routinely used in the participating centers in this study. Instead, we planned a clinical study and, consequently, the incidence of ventilator-associated pneumonia was the parameter used to explore the risk associated with GRV. Control and study groups had a similar frequency of VAP in our study, indicating that a direct relation between GRV and VAP does not seem to exist.