HAIs occur in approximately 12% of PICU patients,1 and 18% to 26% of the infections are pneumonias.2,3 VAP is defined as a hospital-acquired pneumonia that devel- ops in patients who have been treated with mechanical ventilation for 48 hours or longer who had no signs or symptoms of lower respiratory infection before they were intubated and treatment with mechanical ventilation began.4 A more current general definition of VAP for adults and children includes surveillance for complica- tions resulting in deterioration in respiratory status and increased ventilator support after a period of stability or improvement.4,5 VAP is indicated when ventilator settings have been changed because of increased oxygen require- ments and the need for increased inspiratory and expi- ratory pressures during a 2-day or 48-hour period.4,5 A proposed definition is based on complications associated with mechanical ventilation, with consideration given to changing the term from VAP to ventilator-associated complications (VAC), but this change has not yet been accepted or implemented.