Acute Respiratory Distress Syndrome (ARDS) is a heterogeneous lung disease responsible for significant morbidity and mortality among critically ill patients, including those infected with SARS-CoV-2, the virus responsible for COVID-19. Despite recent advances in pathophysiology, diagnostics, and therapeutics, ARDS is dangerously underdiagnosed and supportive lung protective ventilation and prone position remain the mainstay intervention. Rescue therapies including neuromuscular blockade and veno-venous extracorporeal membrane oxygenation (VV-ECMO) remain a key component of clinical practice though benefits are uncertain. While COVID-19 ARDS has some distinguishing features from traditional ARDS, including delayed onset, hyperinflammatory response, and pulmonary microthrombi, it is clinically similar to traditional ARDS and should be treated with established supportive therapies.
Most patients with congenital heart disease have a cardiac shunt whose direction and magnitude can have a major impact on cardiorespiratory physiology and function. The dynamics of the shunt can be significantly altered by anesthetic management and must be understood in order to provide optimal anesthetic care. Given that there are now more adults than children with congenital heart disease and that the majority of nonpediatric patients are cared for in centers without special expertise in congenital heart disease, it is imperative that all anesthesia providers have a general understanding of the subject. This educational review describes a technique to explain this complex subject using simple pictorial diagrams.
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