Abstract: Acute respiratory distress syndrome(ARDS),as a pulmonary manifestations of severe diseases, destroys the effective gas exchange area of the lungs and impairs ventilation function. The heart and lungs are closely related from anatomical location to physiological function, and severe pulmonary lesions inevitably involve the heart, with most significant changes in right heart posterior blood flow, unreasonable mechanical ventilation, inappropriate volume management, and application of vasoactive drugs can get catastrophic consequences on right heart anterior posterior load. The interaction between ventricles leads to a vicious cycle of spontaneous deterioration in right heart dysfunction, resulting in irreversible damage to the body. Bedside ultrasound monitoring in critically ill patients not only helps with the diagnosis of ARDS, but also enables continuously and dynamically monitor changes in the right cardiac unit, achieving targeted treatment of the right heart. The circulatory protection strategy based on lung protection is the cornerstone of treating ARDS and a target for reducing mortality in critically ill patients.

Key words: acute respiratory distress syndrome, acute cor pulmonale, hemodynamics, right heart