Another advantage of LUS is the ability to evaluate the effectiveness of alveolar recruitment manoeuvres with the possibility to visualize real-time imagines of lung parenchyma re-aeration [8, 10, 29] . Finally, pleural effusions can be accurately diagnosed and monitored with LUS and in case of need for treatment an ultra-sound guided technique is recommended [36, 13] . This option seems to be particularly appropriate ECMO patients, where bleeding for conventional chest tube placement can occur in consideration of the need of heparin infusion. 