Abstract: The core management for COVID-19 patients with acute respiratory distress syndrome (ARDS)is hemodynamic therapy, including adjustment to the distribution of blood flow in the lungs and to the changes of blood flow in the right heart-lung circulation. These patients not only have the hemodynamic characteristics of traditional ARDS, but also have special features of COVID-19. Multiple monitoring based on critical care ultrasonography is helpful to describe these features in detail and advance precise treatment that depends on the adjustment to the distribution of pulmonary blood flow-right heart-left heart.