The major goals of any management strategy for patients with true Ventilator-Associated Pneumonia (VAP) are early diagnosis, then adequate doses of the correct antibiotic while avoiding overuse. The use of the wrong antibiotic can have dire consequences. Excessive use or overuse of antibiotics may allow multiple drug resistant strains of pathogens to evolve. According to Chastre, the only way to accomplish these goals is to follow these three steps: 1. Obtain a lower respiratory tract sample for culture and microscopy before introduction of new antibiotics. 2. Immediately start broad spectrum empiric antimicrobial treatment unless signs of sepsis are absent and microscopy is negative. 3. Re-evaluate treatment on day 2 or 3 based upon pathogen identification and clinical outcomes. This document discusses the various methods used in the diagnosis of VAP identifying the advantages and disadvantages of each approach. In addition, the recently introduced Blind Bronchoalveolar Lavage (mini-BAL) method is described in detail.