Roman Ullrich

Roman Ullrich
Medical University of Vienna | MedUni Vienna · Department of Anaesthesia, Critical Care and Pain Medicine

MD

About

117
Publications
11,418
Reads
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2,501
Citations
Additional affiliations
January 2015 - March 2017
Medical University of Vienna
Position
  • Consultant
June 2013 - present
Medical University of Vienna
Position
  • Chief Consultant Intensive Care Medicine
June 2013 - present
Medical University of Vienna
Position
  • Managing Director

Publications

Publications (117)
Article
Full-text available
Background Duration of invasive mechanical ventilation (IMV) prior to extracorporeal membrane oxygenation (ECMO) affects outcome in acute respiratory distress syndrome (ARDS). In coronavirus disease 2019 (COVID-19) related ARDS, the role of pre-ECMO IMV duration is unclear. This single-centre, retrospective study included critically ill adults trea...
Article
Full-text available
Background A profound inflammation-mediated lung injury with long-term acute respiratory distress and high mortality is one of the major complications of critical COVID-19. Immunoglobulin M (IgM)-enriched immunoglobulins seem especially capable of mitigating the inflicted inflammatory harm. However, the efficacy of intravenous IgM-enriched preparat...
Article
Full-text available
Acute respiratory distress syndrome (ARDS) is a major concern in critical care medicine with a high mortality of over 30%. Injury to the lungs is caused not only by underlying pathological conditions such as pneumonia, sepsis, or trauma, but also by ventilator-induced lung injury (VILI) resulting from high positive pressure levels and a high inspir...
Article
Objectives: Ventilator-induced lung injury (VILI) is a major contributor to morbidity and mortality in critically ill patients. Mechanical damage to the lungs is potentially aggravated by the activation of the renin-angiotensin system (RAS). This article describes RAS activation profiles in VILI and discusses the effects of angiotensin (Ang) 1-7 s...
Preprint
Introduction: SARS-CoV-2 gains cell entry via angiotensin-converting enzyme (ACE) 2, a membrane-bound enzyme of the “alternative” (alt) renin-angiotensin system (RAS). ACE2 counteracts angiotensin II by converting it to potentially protective angiotensin 1–7. Methods Using mass spectrometry, we assessed key metabolites of the classical RAS (angiote...
Preprint
Introduction: SARS-CoV-2 gains cell entry via angiotensin-converting enzyme (ACE) 2, a membrane-bound enzyme of the “alternative” (alt) renin-angiotensin system (RAS). ACE2 counteracts angiotensin II by converting it to potentially protective angiotensin 1-7. Methods: Using mass spectrometry, we assessed key metabolites of the classical RAS (angiot...
Article
Full-text available
Electrical impedance segmentography offers a new radiation-free possibility of continuous bedside ventilation monitoring. The aim of this study was to evaluate the efficacy and reproducibility of this bedside tool by comparing synchronized intermittent mandatory ventilation (SIMV) with neurally adjusted ventilatory assist (NAVA) in critically-ill c...
Article
Background and Aims Skeletal muscle area (SMA) in the computed tomography (CT) at the third lumbar vertebra (L3) level is a proxy for whole-body muscle mass but is only performed for clinical reasons. Ultrasound is a promising tool to determine muscle mass at the bedside. It is still unclear how well ultrasound and which ultrasound measuring points...
Article
Full-text available
Supplemental oxygen is frequently used together with mechanical ventilation to achieve sufficient blood oxygenation. Despite the undoubted benefits, it is vigorously debated whether too much oxygen can also have unpredicted side-effects. Uncertainty is also due to the fact that the molecular mechanisms are still insufficiently understood. The lung...
Article
Full-text available
Background The ISARIC prospective multinational observational study is the largest cohort of hospitalized patients with COVID-19. We present relationships of age, sex, and nationality to presenting symptoms. Methods International, prospective observational study of 60 109 hospitalized symptomatic patients with laboratory-confirmed COVID-19 recruit...
Article
Full-text available
Background Acute respiratory distress syndrome (ARDS) is a complex clinical diagnosis with various possible etiologies. One common feature, however, is pulmonary permeability edema, which leads to an increased alveolar diffusion pathway and, subsequently, impaired oxygenation and decarboxylation. A novel inhaled peptide agent (AP301, solnatide) was...
Article
OBJECTIVES The aim of this study was to investigate the load and composition of cerebral microemboli in adult patients undergoing venoarterial extracorporeal life support (ECLS). METHODS Adult ECLS patients were investigated for the presence of cerebral microemboli and compared to critically ill, pressure-controlled ventilated controls and healthy...
Preprint
Full-text available
Background Acute respiratory distress syndrome (ARDS) is a complex clinical diagnosis with various possible etiologies. One common feature, however, is pulmonary permeability edema, which leads to an increased alveolar diffusion pathway and, subsequently, impaired oxygenation and decarboxylation. A novel inhaled peptide agent (AP301, solnatide) was...
Article
Full-text available
CO2 removal via membrane oxygenators during lung protective ventilation has become a reliable clinical technique. For further optimization of oxygenators, accurate prediction of the CO2 removal rate is necessary. It can either be determined by measuring the CO2 content in the exhaust gas of the oxygenator (sweep flow‐based) or using blood gas analy...
Preprint
Full-text available
Background: Assessing relative differences of integrated impedance as a surrogate of volume changes between neurally adjusted ventilatory assist (NAVA) and synchronized intermittent mandatory ventilation (SIMV) by using electric impedance segmentography in children. Methods: Performed as a prospective randomized case-control crossover trial in a pe...
Article
Extracorporeal membrane oxygenation (ECMO) has established as a cornerstone therapy in severe acute respiratory distress syndrome and refractory hemodynamic failure. As circuit integrity is crucial for adequate organ support, component failure may necessitate a system exchange. In this retrospective study, incidence and etiology of system exchanges...
Article
Full-text available
The pulmonary endothelium is an immediate recipient of high oxygen concentrations upon oxygen therapy and mediates downstream responses. Cyclic collapse and reopening of atelectatic lung areas during mechanical ventilation with high fractions of inspired oxygen result in the propagation of oxygen oscillations in the hypoxic/hy-peroxic range. We use...
Article
Full-text available
Coronavirus disease 2019 (COVID-19) progresses mildly in most of the cases; however, about 5% of the patients develop a severe acute respiratory distress syndrome (ARDS). Of all COVID-19 patients 3% need intensive care treatment, which becomes a great challenge for anesthesiology and intensive care medicine, medically, hygienically and for technica...
Article
Full-text available
Soon after its discovery in the 18th century, oxygen was applied as a therapeutic agent to treat severely ill patients. Lack of oxygen, commonly termed as hypoxia, is frequently encountered in different disease states and is detrimental to human life. However, at the end of the 19th century, Paul Bert and James Lorrain Smith identified what is know...
Article
Full-text available
The pandemic from the SARS-CoV‑2 virus is currently challenging healthcare systems all over the world. Maintaining appropriate staffing and resources in healthcare facilities is essential to guarantee a safe working environment for healthcare personnel and safe patient care. Extracorporeal membrane oxygenation (ECMO) represents a valuable therapeut...
Article
Full-text available
Zusammenfassung Die aktuelle COVID-19-Pandemie, die durch das SARS-CoV‑2 ausgelöst wird, hat bereits in vielen betroffenen Ländern zu gravierenden Ressourcenengpässen der jeweiligen Gesundheitssysteme geführt. Obwohl sehr viele COVID-19-Patienten nur moderate Symptome zeigen, entwickelt eine Subgruppe ein schweres respiratorisches oder auch kardial...
Article
Full-text available
Computational fluid dynamics (CFD) provides a flexible tool for investigation of separation processes within membrane hollow fiber modules. By enabling a three-dimensional and time dependent description of the corresponding transport phenomena, very detailed information about mass transfer or geometrical influences can be provided. The high level o...
Article
Full-text available
Background Experimental and volunteer studies have reported pulmonary vasoconstriction during transfusion of packed red blood cells (PRBCs) stored for prolonged periods. The primary aim of this study was to evaluate whether transfusion of PRBCs stored over 21 days (standard-issue, siPRBCs) increases pulmonary artery pressure (PAP) to a greater exte...
Data
Laboratory values of study participants prior to transfusion. Data are depicted as mean±standard deviation. Abbreviations: PRBCs, packed red blood cells. (DOC)
Data
Complete anonymized dataset of the study population. Abbreviations: AH, arterial hypertension; AS, aortic stenosis; AVR, aortic valve replacement; CABG, coronary artery bypass graft; CAD, coronary artery disease; CMP, cardiomyopathy; COPD, chronic obstructive pulmonary disease; FHB, free hemoglobin; GERD, gastro-esophageal reflux disease; HLP, hype...
Data
Original German version of the study protocol. (PDF)
Data
Checklist of information required for reporting a randomised trial. (DOC)
Data
Results of ANCOVA for the increase within 15 minutes during transfusion as the dependent variable. Abbreviations: ANCOVA, analysis of co-variance; CI, cardiac index; FHB, free hemoglobin; MAP, mean arterial pressure; PAP, pulmonary arterial pressure; PRBC, packed red blood cells; PVRI, pulmonary vascular resistance index; SVRI, systemic vascular re...
Data
English translation of the study protocol. (PDF)
Article
Full-text available
Background Peritonitis is responsible for thousands of deaths annually in Germany alone. Even source control (SC) and antibiotic treatment often fail to prevent severe sepsis or septic shock, and this situation has hardly improved in the past two decades. Most experimental immunomodulatory therapeutics for sepsis have been aimed at blocking or damp...
Article
Objective:: Patients on extracorporeal membrane oxygenation are frequently in need for sedation. Use of propofol has been associated with impaired oxygenator function due to adsorption to the membrane as well as lipid load. The aim of our retrospective analysis was to compare two different sedation regimens containing either propofol or midazolam...
Conference Paper
Full-text available
Currently available treatment methods for acute lung failure show high rates of complications. There is an urgent need for alternative treatment methods. A catheter device which can be minimal invasively inserted into the vena cava for intracorporeal gas exchange was developed. Main components of the device are a drive unit and a membrane module. I...
Poster
Full-text available
Objectives Although extracorporeal membrane oxygenators have developed to a reliable respiratory technique, the development of intracorporeal devices remains a challenge due to anatomical limitations. To meet these constraints while delivering significant blood gas exchange, highly efficient devices need to be developed. Methods Experimental metho...
Article
Background: Critically ill patients with acute respiratory failure admitted to an intensive care unit are at high risk for cerebral hypoxia. We investigated the impact of continuous positive airway pressure (CPAP) therapy on regional cerebral tissue oxygenation (rSO2). Materials and methods: In total, 40 extubated surgical intensive care unit pa...
Article
Full-text available
Acute respiratory distress syndrome (ARDS) is characterized by acute diffuse lung injury, which results in increased pulmonary vascular permeability and loss of aerated lung tissue. This causes bilateral opacity consistent with pulmonary edema, hypoxemia, increased venous admixture, and decreased lung compliance such that patients with ARDS need su...
Article
Full-text available
Background: Mechanical ventilation with oxygen is life-saving, however, may result in hyperoxia. The aim was to analyse the incidence and duration of hyperoxia burden and related in-hospital mortality in critically ill patients. Methods: Patients of all ages admitted to intensive care units (ICUs) and with mechanical ventilation for at least sev...
Article
Full-text available
Background: High-permeability pulmonary edema is a hallmark of acute respiratory distress syndrome (ARDS) and is frequently accompanied by impaired alveolar fluid clearance (AFC). AP301 enhances AFC by activating epithelial sodium channels (ENaCs) on alveolar epithelial cells, and we investigated its effect on extravascular lung water index (EVLWI...
Conference Paper
Full-text available
Background: An approach to prevent acute respiratory distress syndrome (ARDS) is to reduce CO2 concentration in blood before it reaches the lungs. This can be achieved using an intracorporeal membrane catheter in which CO2 is transferred from blood side to the other fluid which is pumped to outside of the body. CO2 is removed and the secondary flui...
Article
Background: Primary graft dysfunction (PGD) after lung transplantation (LTx) carries significant morbidity and mortality in the early post-operative period and is associated with the development of chronic lung allograft dysfunction. AP301, an activator of epithelial sodium channel-mediated Na(+) uptake represents a new concept for prevention and...
Article
Full-text available
Background: Cerebral microemboli (ME) are frequently generated during orthopaedic surgery and may impair cerebral integrity. However, the nature of cerebral ME, being either of solid or gaseous origin, is poorly investigated. Our primary aim was to determine both the frequency and nature of cerebral ME in generally anaesthetised patients undergoin...
Article
Full-text available
Supplemental oxygen (O2) is used as adjunct therapy in anesthesia, emergency and intensive care medicine. We hypothesized that excessive O2 levels (hyperoxia) can directly injure human adult cardiac myocytes (HACMs). HACMs obtained from the explanted hearts of transplantation patients were exposed to constant hyperoxia (95% O2), intermittent hypero...
Article
Background: Oxidative stress is the predominant pathogenic mechanism of ischaemia-reperfusion (IR) injury. The noble gas argon has been shown to alleviate oxidative stress-related myocardial and cerebral injury. The risk of lung IR injury is increased in some major surgeries, reducing clinical outcome. However, no study has examined the lung-prote...
Article
Background: Continuous venovenous hemodialysis (CVVHD) may generate microemboli that cross the pulmonary circulation and reach the brain. The aim of the present study was to quantify (load per time interval) and qualify (gaseous vs. solid) cerebral microemboli (CME), detected as high-intensity transient signals, using transcranial Doppler ultrasou...
Article
Full-text available
Background: Intermittent hypoxia may occur in a number of clinical scenarios, including interruption of myocardial blood flow or breathing disorders such as obstructive sleep apnea. Although intermittent hypoxia has been linked to cardiovascular and cerebrovascular disease, the effect of intermittent hypoxia on the human heart is not fully underst...
Article
Background: Perioperative high-dose oxygen (O2 ) exposure can cause hyperoxia. While the effect of constant hyperoxia on the vascular endothelium has been investigated to some extent, the impact of cyclic hyperoxia largely remains unknown. We hypothesized that cyclic hyperoxia would induce more injury than constant hyperoxia to human umbilical vei...
Conference Paper
Background: PGD following LuTX carries significant morbidity and mortality. AP301, an activator of ENaC-mediated Na(+) uptake represents a new concept for treatment of hyper-permeability oedema with promising preclinical results. Aims: This study aims to investigate the effect of AP301 on patients with PGD≥1 at ICU arrival after LuTX. Methods: Pros...
Article
Little is known about real-time in-vivo microscopy of pulmonary capillary perfusion because current microscopy requires direct access to lung tissue with surgical intervention such as the thoracic-window technique and open-lung model. To evaluate if probe-based confocal laser scanning endomicroscopy (pCLE) via the trachea allows for real-time in-vi...
Article
Full-text available
Cyclic recruitment and derecruitment of atelectasis can occur during mechanical ventilation, especially in injured lungs. Experimentally, cyclic recruitment and derecruitment can be quantified by respiration-dependent changes in PaO2 (ΔPaO2), reflecting the varying intrapulmonary shunt fraction within the respiratory cycle. This study investigated...
Article
In patients awaiting lung transplantation (LTX), adequate gas exchange may not be sufficiently achieved by mechanical ventilation alone if acute respiratory decompensation arises. We report on 20 patients with life-threatening hypercapnia who received extracorporeal CO2-removal (ECCO2-R) by means of the interventional lung assist (ILA®, Novalung, G...
Article
Full-text available
Vibration response imaging (VRI) is a bedside technology to monitor ventilation by detecting lung sound vibrations. It is currently unknown whether VRI is able to accurately monitor the local distribution of ventilation within the lungs. We therefore compared VRI to electrical impedance tomography (EIT), an established technique used for the assess...
Article
Full-text available
Acute respiratory failure (ARF) is the main reason for intensive care unit (ICU) admissions in patients with hematologic malignancies (HM). We report the first series of adult patients with ARF and HM treated with extracorporeal membrane oxygenation (ECMO). This is a retrospective cohort study on 14 patients with HM (aggressive non-Hodgkin lymphoma...
Article
Full-text available
In pressure support ventilation (PSV), a non-variable level of pressure support is delivered by the ventilator when triggered by the patient. In contrast, variable PSV delivers a level of pressure support that varies in a random fashion, introducing more physiological variability to the respiratory pattern. Experimental studies show that variable P...