CMV disease and acute respiratory distress syndrome or ventilator-associated pneumonia CMV pneumonia was diagnosed by open-lung biopsy while investigating the etiology of pulmonary disease in 29 to 50% of critically ill patients with ARDS or VAP (Table 2 ) [29] [30] [31] . In a study in which open-lung biopsy led to the diagnosis of CMV pneumonia in 30% of critically ill patients with ARDS, lung tissue culture was positive only in 10% of these patients [29] . The sensitivity/specificity of bronchoalveolar lavage (BAL), blood, and urine culture for the diagnosis of histologically proven ventilator-associated CMV pneumonia was 53%/92%, 20%/83%, and 13%/62%, respectively [31] . Clinical outcome data were largely lacking; however, there was no difference in duration of ICU stay in one study [31] .