Background and Purpose: Prolonged mechanical ventilation (PMV) is associ-ated with a disproportionate use of intensive care units and hospital resources and high in-hospital and postdischarge mortality. Ventilator-associated pneumonia (VAP) is one of the most common infections in patients requiring PMV. Objectives: This study analyzed real-world data from Taiwan’s National Health Insurance Research Database to evaluate the impact of VAP on medical care among patients with PMV. Methods: This study was a nested case-control study. Cases were PMV patients with newly diagnosed pneumonia (n=2,248) and controls were PMV patients without com-plicated pneumonia (n=2,248). Odds ratios (ORs) and 95% confidence intervals (CIs) derived from conditional logistic regression models were used to evaluate the impact of PMV with or without pneumonia on medical care. Results: Cases with VAP was associated with a significantly higher risk of admission to rotary ICU (adjusted OR, 1.27; 95% CI, 1.12-1.45), return down home care (adjusted OR, 2.00; 95% CI, 1.38-2.90), and return down respiratory care ward (adjusted OR, 2.01; 95% CI, 1.76-2.30), as compared with controls with non-pneumonia PMV. Conclusion: This study demonstrates that VAP might be a crucial factor for medical care among pa-tients with PMV. Our results are highly clinically relevant for the management of pa-tients with PMV. Future prospective studies is warranted to validate our findings.