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The best (and fastest) way to evaluate for & is with point of care ultrasound.

Looking for bubbles in the LA after agitated saline can help spot a PFO. Measuring LVOT VTI at different PEEPs can be very helpful in titrating.

It's also worth remembering that anyone who worsens on mechanical ventilation, could have developed a pneumothorax. Yet another good reason to use POCUS in your workup of someone with worsening hypoxemia!

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