Although experimental findings support the protective impact of statins in the setting of VAP, strong clinical evidence is still lacking. Actually, the only large multicenter RCT published so far showed that atorvastatin had no effect on the outcome of patients with suspected VAP . However, we have shown that statin treatment prior to VAP was an independent predictor of ICU survival . Similarly, it has been shown by one RCT that overall mortality was reduced in patients with the most severe VAP who received statin prior to infection, as already demonstrated previously in another trial, which included patients with sepsis from various origins [35, 36]. Thus, one cannot exclude the possibility that statins could be beneficial to the host only if given prior to the infection, as was the case in our model. Several explanations could be proposed: (i) more than one administration of the drug is required before critical concentrations in the blood and lung are reached; (ii) the clinical suspicion of VAP is probably later than the actual onset of pneumonia (i.e., airway challenge with bacteria triggering the immune response); (iii) immunomodulation has to occur very early during sepsis in order to prevent any overwhelming pro-inflammatory response.