EP2549921A1 - Endotracheal tube - Google Patents

Endotracheal tube

Info

Publication number
EP2549921A1
EP2549921A1 EP11713085A EP11713085A EP2549921A1 EP 2549921 A1 EP2549921 A1 EP 2549921A1 EP 11713085 A EP11713085 A EP 11713085A EP 11713085 A EP11713085 A EP 11713085A EP 2549921 A1 EP2549921 A1 EP 2549921A1
Authority
EP
European Patent Office
Prior art keywords
contact
tube
electrode
contact region
tubus
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Withdrawn
Application number
EP11713085A
Other languages
German (de)
French (fr)
Inventor
Andreas Langer
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
DR LANGER MEDICAL GmbH
Original Assignee
DR LANGER MEDICAL GmbH
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by DR LANGER MEDICAL GmbH filed Critical DR LANGER MEDICAL GmbH
Publication of EP2549921A1 publication Critical patent/EP2549921A1/en
Withdrawn legal-status Critical Current

Links

Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283—Invasive
    • A61B5/285—Endotracheal, oesophageal or gastric probes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/28—Bioelectric electrodes therefor specially adapted for particular uses for electrocardiography [ECG]
    • A61B5/283—Invasive
    • A61B5/287—Holders for multiple electrodes, e.g. electrode catheters for electrophysiological study [EPS]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/24—Detecting, measuring or recording bioelectric or biomagnetic signals of the body or parts thereof
    • A61B5/25—Bioelectric electrodes therefor
    • A61B5/279—Bioelectric electrodes therefor specially adapted for particular uses
    • A61B5/296—Bioelectric electrodes therefor specially adapted for particular uses for electromyography [EMG]
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/48—Other medical applications
    • A61B5/4887—Locating particular structures in or on the body
    • A61B5/4893—Nerves
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B5/00—Measuring for diagnostic purposes; Identification of persons
    • A61B5/68—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient
    • A61B5/6801—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be attached to or worn on the body surface
    • A61B5/683—Means for maintaining contact with the body
    • A61B5/6835—Supports or holders, e.g., articulated arms
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B1/00—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor
    • A61B1/267—Instruments for performing medical examinations of the interior of cavities or tubes of the body by visual or photographical inspection, e.g. endoscopes; Illuminating arrangements therefor for the respiratory tract, e.g. laryngoscopes, bronchoscopes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2230/00—Measuring parameters of the user
    • A61M2230/60—Muscle strain, i.e. measured on the user

Definitions

  • the invention relates to a Endotracheal tube with a tube tube and at least one Contact electrode for attachment to at least one vocal cord a patient intubated with the tube.
  • Surgical procedures in the cervical region of a patient involve the risk of injury to the nerves in the operating area, especially the recurrent laryngeal nerve , resulting in voice disturbances, loss of voice and / or respiratory or swallowing discomfort in the patient.
  • a bilateral injury of the branching off of the vagus nerve laryngeal nerve in Strumaoperationen exists for the patient even mortal danger.
  • the object of the invention is to provide a To provide endotracheal tube of the type mentioned, with the contact with the vocal cords reliable manufactured and throughout the operation can be maintained.
  • the contact electrode at least one Tubus tube in a contact area at least approximately having circumferentially surrounding conductor loop.
  • the contact electrode with the Tubusrohr the conductor loop at least approximately to the entire Surrounds tube circumference, the tube during intubation or during the duration of the operation relative to it in itself desired position to be twisted without the Contact electrode loses contact with the vocal cords.
  • the contact electrode several conductor loops on which the Tubusrohr in Contact area surrounded by rings or spirals. hereby will potentially have multiple contact points between the Contact electrode and the vocal cords of the patient over the Length of the contact area created so that it is ensured that the tube after intubating the Patients with at least one conductor loop to the Vocal cords is present.
  • the contact electrodes can several, in particular be provided two contact electrodes whose Conductor loops alternately at the contact area of the Tubusrohrs are arranged, wherein the contact electrodes then preferably have different polarities and thus form at least one bipolar electrode.
  • each Contact electrode a first, the Tubusrohr spiral surrounding section and a second, the Tubusrohr having spirally surrounding portion, wherein the Conductor grinding the two electrode sections each other are arranged alternately in the manner of a double helix.
  • the two electrode sections can at this Embodiment on a caudal or a cranial end be connected to each other of the contact area.
  • the contact area can be a length between about 40 mm and 80 mm, preferably between 50 and 70 mm have, then each contact electrode and / or each Electrode section over the length of the contact surface between four and twelve conductor loops, preferably between six and ten conductor loops around the tube tube forms.
  • a contact electrode may be made, for example a glued to the tube tube in the contact area Conductor wire exist. But is particularly advantageous Embodiment in which the contact electrode (s) of a applied to the Tubusrohrau builtseite, electrically conductive paint or a polymeric material formed will / will, for example, directly on the tube tube is injected.
  • the contact electrode (s) is / are on at least one at the cranial end of the Tubusrohrs arranged contact connection via at least one am Tubusrohr along arranged connecting line connected.
  • the at least one Connecting line also made of electrically conductive Lacquer or molded, electrically conductive Polymer material may be formed.
  • At the contact area can then after intubating the patient one Contact sleeve or the like can be created, which is via cable is connected to the evaluation electronics, the Surgeon holding the vocal cords of the patient indicates removed response signals to the nerve excitation.
  • a particularly universally applicable Embodiment of the tube according to the invention is obtained, if the Tubusrohr in the contact area with two Contact electrodes each provided with two electrode sections is, with all electrode sections the contact area entwine spirally in the same direction and each other are arranged alternately.
  • quadruple spiral arrangement are then suitably the first Electrode portion of the first contact electrode, the first Electrode portion of the second contact electrode, the second electrode portion of the first contact electrode and the second electrode portion of the second contact electrode in this order next to each other.
  • the Electrode portions of the first contact electrode can then at the cranial end of the contact area with each other be connected and the electrode sections of the second Contact electrode may be at the caudal end of the Contact area to be interconnected.
  • FIG. 1 shows the head of a patient intubated with an endotracheal tube according to the invention in vertical section;
  • FIG. 2 shows the tube according to the invention in the extended state in a side view.
  • Fig. 3 shows the subject of Figure 2 in section along the line III-III.
  • Fig. 4 shows a detail IV of the tube of FIG. 2 in a perspective view.
  • the patient shown in Fig. 1 is in known manner intubated with an endotracheal tube 10, with its caudal end 11 into the trachea 12 of the Patient stands out and there by means of one over one Balloon line 13 inflatable block cuff 14 (cuff) set against the trachea 12 and sealed can be.
  • Balloon line 13 inflatable block cuff 14 (cuff) set against the trachea 12 and sealed can be.
  • Above the block cuff 14 has the Tubusrohr 15 of the tube 10 a contact area 16, the attached to the vocal cords 17 of the patient, of which in Fig. 1 only one can be seen.
  • the tube 10 is provided with two contact electrodes 18, 19, the changes in the electrical action potentials of the Measuring vocal cords to which they rest.
  • both contact electrodes 18, 19 in the contact region 16 of the tube 10 is the subject of present invention; it is in Figs. 2 to 4 in Detail recognizable. Thereafter, both contact electrodes 18, 19 a plurality of conductor loops 20, which the tube tube 15th surrounded spirally in the contact region 16. The arrangement is made such that the of the first contact electrode 18th formed conductor loops 20 'always between the Conductor loops 20 '' of the second contact electrode 19, so take turns with them.
  • each of the two contact electrodes 18, 19 forms a first surrounding the Tubusrohr spirally Section 18a, 19a and a second the Tubusrohr spirally surrounding portion 18b, 19b, wherein the Conductor grinding the two electrode sections of a each contact electrode alternately in the manner of a Double helix are arranged and the four altogether Electrode portions 18a, 19a, 18b, 19b around each 90 ° to each other (Fig. 3) successively order Wind the contact area of the tube tube.
  • the two Electrode portions 18a, 18b of the first contact electrode are directly at the cranial end 24 of the Tubusrohres connected above the block cuff 14, while the electrode portions 19a, 19b of the second Contact electrode 19 at the caudal end 11 of the contact area 16 converge.
  • Both the contact electrodes and the these connecting to the contact terminal 23 Connecting lines 21, 22 consist of an electric conductive, on the surface of the Tubusrohrs or Contact area of molded polymer material containing a similar flexibility as the tube tube itself has and that can go through its deformations without doing so to be damaged or to detach from the tube tube.
  • the electrical conductivity or resistivity is used for coming contact electrode material known by experiments and changes through the Deformations that the tube in its handling does not go through, so the signals as a result of a Change of electrical action potentials at Unadulterated vocal cord muscle to the display and Evaluation unit to be transmitted.
  • the contact region 16 has a length of about 60 mm, each contact electrode section respectively eight conductor loops 20 forms the contact area entwine. Due to the large number of possible Contact points with the vocal cords that run the length of the contact area is a reliable contact between the contact electrodes and the vocal cord muscles always guaranteed. Since the contact area over his entire circumference with the conductor loops of Contact electrodes is provided, can also be a twisting of the Tubus in the trachea does not cause that Tubus tube with a portion of the vocal cords, where there are no contact electrodes, what with previously known endotracheal tubes, the intraoperative neuromonitoring were used posed a potential problem with the reliability of the monitoring.
  • the invention is not on the illustrated and described embodiment limited, but there are different changes and Supplements conceivable, without the scope of the invention leave.
  • the contact electrodes in the Tubusrohr Wrap the contact area in a spiral even if this is the case in particular in the case of the above-described and illustrated bipolar arrangement of contact electrodes is particularly advantageous.
  • the conductor loops as self-contained, the Contact area annularly surrounding design then train all over a common, axial extending connecting line, which is on the outside of the Tubusrohrs runs up to the block cuff, in Contact with the contact terminal are brought.
  • a comparable design can also be used for bipolar Realize electrodes when the annular applied Conductor loops not circumferentially closed, but on a place are interrupted, through which then the connecting line of the other contact electrode can go through without causing a short circuit with the first electrode comes.
  • the invention not only for continuous neuromonitoring but can also be used in cases where where the nerve to be monitored is manually stimulated.

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  • Health & Medical Sciences (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Veterinary Medicine (AREA)
  • Public Health (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • General Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Physics & Mathematics (AREA)
  • Molecular Biology (AREA)
  • Medical Informatics (AREA)
  • Pathology (AREA)
  • Biophysics (AREA)
  • Pulmonology (AREA)
  • Cardiology (AREA)
  • Emergency Medicine (AREA)
  • Anesthesiology (AREA)
  • Hematology (AREA)
  • Physiology (AREA)
  • Neurology (AREA)
  • Electrotherapy Devices (AREA)

Abstract

An endotracheal tube with a tube part and a contact electrode for bearing on at least one vocal cord of a patient intubated with the tube. According to the invention, in order to produce and maintain reliable contact between the vocal cords of the patient and the contact electrode for the duration of an operation, provision is made that the contact electrode (18; 19) has at least one conductor loop (20) at least approximately circumferentially surrounding the tube part (15) in a contact area (16). (See Figure 2)

Description

    ENDOTRACHEALTUBUS  endotracheal tube
  • Die Erfindung betrifft einen Endotrachealtubus mit einem Tubusrohr und mindestens einer Kontaktelektrode zur Anlage an mindestens einem Stimmband eines mit dem Tubus intubierten Patienten.The invention relates to a             Endotracheal tube with a tube tube and at least one             Contact electrode for attachment to at least one vocal cord             a patient intubated with the tube.
  • Bei chirurgischen Eingriffen im Halsbereich eines Patienten wie insbesondere bei Schilddrüsenoperationen besteht die Gefahr einer Verletzung der im Operationsgebiet liegenden Nerven, insbesondere des Nervus laryngeus recurrens , was zu Stimmstörungen, einem Verlust der Stimme und/oder zu Respirations- oder Schluckbeschwerden beim Patienten führt. Im Falle einer beidseitigen Verletzung des aus dem Nervus vagus abzweigenden Nervus laryngeus bei Strumaoperationen besteht für den Patienten sogar Lebensgefahr.Surgical procedures in the cervical region of a patient, in particular thyroid surgery, involve the risk of injury to the nerves in the operating area, especially the recurrent laryngeal nerve , resulting in voice disturbances, loss of voice and / or respiratory or swallowing discomfort in the patient. In the case of a bilateral injury of the branching off of the vagus nerve laryngeal nerve in Strumaoperationen exists for the patient even mortal danger.
  • Durch den Einsatz der Funktionsüberwachung von Nerven bei der Operation kann auch in der Schilddrüsenchirurgie diese am häufigsten auftretende und gefährliche Komplikation, nämlich die auch als Recurrensparese bezeichnete Verletzung des Nervus laryngeus recurrens weitgehend ausgeschaltet werden. Während früher ein intermittierendes Neuromonitoring durch den Operateur bei der Identifikation eines gefährdeten Nervs sowie der Überprüfung der Nervenfunktion zum Einsatz kam, ist in jüngerer Vergangenheit ein kontinuierliches Überwachungsverfahren vorgeschlagen worden, bei dem an zu überwachenden Nerven für die Dauer einer Operation eine Elektrode angelegt wird, mit welcher der Nerv ohne manuelle Tätigkeit des Operateurs fortlaufend oder in kurzen zeitlichen Abständen erregt und das hierauf erfolgende Antwortsignal am Erfolgsmuskel, nämlich den Stimmbändern des Patienten abgeleitet und dem Operateur über ein geeignetes Anzeigegerät angezeigt wird. Um das Antwortsignal an den Stimmbändern des Patienten feststellen zu können, ist eine in Kontakt mit den Stimmbändern bringbare Kontaktelektrode erforderlich. Hierzu schlägt die EP 0 438 863 A1 ein Ableitsystem an einem Endotrachealtubus vor, bei dem am Tubusrohr parallel zur Tubusachse zwei Drähte einander gegenüberliegend angebracht sind, von denen jeder die elektrische Aktivität je eines der beiden Stimmbänder erfassen soll. Eine sichere Ableitung ist dadurch jedoch nicht möglich, da es schon bei leichter Drehung oder Bewegung des Tubus dazu kommen kann, dass der Kontakt zwischen den Stimmbändern und den Drahtelektroden verloren geht, so dass eine drohende Läsion des im Operationsgebiet liegenden Nervs und insbesondere ein kontinuierliches Neuromonitoring mit dem bekannten Tubus nicht zuverlässig erfolgen kann. Through the use of function monitoring             of nerves at surgery can also be in the             Thyroid surgery these most commonly occurring and             dangerous complication, namely as well             Recurrent palsy referred to injury to the nerve             Laryngeal recurrents are largely eliminated.             While earlier an intermittent neuromonitoring by             the surgeon in the identification of an endangered             Nervus and the verification of nerve function for use             has been a continuous one in the recent past             Monitoring method has been proposed in which to             monitoring nerves for the duration of an operation             Electrode is applied, with which the nerve without             manual operation of the surgeon continuously or in             short time intervals excited and that on it             successful response signal on successful muscle, namely the             The vocal cords of the patient are derived and the surgeon             is displayed via a suitable display device. To that             Detect the response signal to the vocal cords of the patient             To be able to, is one in contact with the vocal cords             bringable contact electrode required. Suggests this             EP 0 438 863 A1 discloses a lead-off system on a             Endotracheal tube in front, at the Tubusrohr parallel to             Tube axis two wires opposite each other             are attached, each of which is the electrical activity             each should capture one of the two vocal cords. A safe             However, derivation is not possible because it already             with slight rotation or movement of the tube to come             can that be the contact between the vocal cords and the             Wire electrodes are lost, leaving a threatening lesion             of the nerve lying in the operating area and in particular             a continuous neuromonitoring with the known             Tube can not be done reliably.
  • Selbst wenn man die Tubuselektroden, die rechts- und linksseitig am Tubusrohr bekannter Tuben vorgesehen sind, mit einer größeren Kontaktfläche ausstattet, verbleiben zwischen den beiden Kontaktelektroden immer noch Bereiche, welche die elektrische Aktivität der Stimmbänder nicht erfassen können. Wenn das Tubusrohr beim Intubieren nicht korrekt platziert wird, kann es also auch bei Tuben mit breiteren Kontaktelektroden dazu kommen, dass ein Kontakt der Elektroden mit den Stimmbändern nicht gewährleistet ist, so dass keine Signale mehr gemessen werden können, was das Risiko einer Nervverletzung aufgrund falsch-negativer Signalantworten erheblich erhöht.Even if the tube electrodes, the             on the right and left side at the tube tube of known tubes             are provided, with a larger contact area             equips remain between the two contact electrodes             still areas showing the electrical activity of the             Can not capture vocal cords. When the tube tube at             Intubation is not placed correctly, so it can be too             in tubes with wider contact electrodes,             that contact of the electrodes with the vocal cords is not             is guaranteed so that no signals are measured anymore             which may be the risk of a nerve injury             significantly increased due to false-negative signal responses.
  • Aufgabe der Erfindung ist es, einen Endotrachealtubus der eingangsgenannten Art zu schaffen, mit dem der Kontakt zu den Stimmbändern zuverlässig hergestellt und während der ganzen Operation aufrechterhalten werden kann.The object of the invention is to provide a             To provide endotracheal tube of the type mentioned,             with the contact with the vocal cords reliable             manufactured and throughout the operation             can be maintained.
  • Diese Aufgabe wird mit der Erfindung dadurch gelöst, dass die Kontaktelektrode mindestens eine das Tubusrohr in einem Kontaktbereich wenigstens annähernd umlaufend umgebende Leiterschleife aufweist.This object is achieved with the invention             solved that the contact electrode at least one             Tubus tube in a contact area at least approximately             having circumferentially surrounding conductor loop.
  • Da die Kontaktelektrode das Tubusrohr mit der Leiterschleife zumindest annähernd um den gesamten Rohrumfang umgibt, kann der Tubus beim Intubieren oder während der Dauer der Operation relativ zu seiner an sich gewünschten Lage verdreht werden, ohne dass die Kontaktelektrode den Kontakt mit den Stimmbändern verliert.Since the contact electrode with the Tubusrohr             the conductor loop at least approximately to the entire             Surrounds tube circumference, the tube during intubation or             during the duration of the operation relative to it in itself             desired position to be twisted without the             Contact electrode loses contact with the vocal cords.
  • Vorzugsweise weist die Kontaktelektrode mehrere Leiterschleifen auf, die das Tubusrohr im Kontaktbereich ring- oder spiralförmig umgeben. Hierdurch werden potentiell mehrere Kontaktstellen zwischen der Kontaktelektrode und den Stimmbändern des Patienten über die Länge des Kontaktbereiches geschaffen, so dass sichergestellt ist, dass der Tubus nach dem Intubieren des Patienten mit wenigstens einer Leiterschleife an den Stimmbändern anliegt. In besonders vorteilhafter Weiterbildung der Erfindung können mehrere, insbesondere zwei Kontaktelektroden vorgesehen sein, deren Leiterschleifen einander abwechselnd am Kontaktbereich des Tubusrohrs angeordnet sind, wobei die Kontaktelektroden dann vorzugsweise unterschiedliche Polaritäten haben und somit mindestens eine bipolare Elektrode bilden.Preferably, the contact electrode             several conductor loops on which the Tubusrohr in             Contact area surrounded by rings or spirals. hereby             will potentially have multiple contact points between the             Contact electrode and the vocal cords of the patient over the             Length of the contact area created so that             it is ensured that the tube after intubating the             Patients with at least one conductor loop to the             Vocal cords is present. In particularly advantageous             Further development of the invention can several, in particular             be provided two contact electrodes whose             Conductor loops alternately at the contact area of the             Tubusrohrs are arranged, wherein the contact electrodes             then preferably have different polarities and             thus form at least one bipolar electrode.
  • Weiter vorteilhaft ist es, wenn jede Kontaktelektrode einen ersten, das Tubusrohr spiralförmig umgebenden Abschnitt und einen zweiten, das Tubusrohr spiralförmig umgebenden Abschnitt aufweist, wobei die Leiterschleifen der beiden Elektrodenabschnitte einander abwechselnd nach Art einer Doppelhelix angeordnet sind. Die beiden Elektrodenabschnitte können bei dieser Ausführungsform an einem caudalen oder einem kranialen Ende des Kontaktbereiches miteinander verbunden sein.It is also advantageous if each             Contact electrode a first, the Tubusrohr spiral             surrounding section and a second, the Tubusrohr             having spirally surrounding portion, wherein the             Conductor grinding the two electrode sections each other             are arranged alternately in the manner of a double helix.             The two electrode sections can at this             Embodiment on a caudal or a cranial end             be connected to each other of the contact area.
  • Der Kontaktbereich kann eine Länge zwischen etwa 40 mm und 80 mm, bevorzugt zwischen 50 und 70 mm haben, wobei dann jede Kontaktelektrode und/oder jeder Elektrodenabschnitt über die Länge der Kontaktfläche zwischen vier und zwölf Leiterschleifen, vorzugsweise zwischen sechs und zehn Leiterschleifen um das Tubusrohr bildet. Eine Kontaktelektrode kann beispielsweise aus einem am Tubusrohr im Kontaktbereich aufgeklebten Leiterdraht bestehen. Besonders vorteilhaft ist aber eine Ausführungsform, bei der die Kontaktelektrode(n) von einem an der Tubusrohraußenseite aufgetragenen, elektrisch leitfähigen Lack oder einem Polymermaterial gebildet wird/werden, das beispielsweise direkt am Tubusrohr angespritzt wird.The contact area can be a length between             about 40 mm and 80 mm, preferably between 50 and 70 mm             have, then each contact electrode and / or each             Electrode section over the length of the contact surface             between four and twelve conductor loops, preferably             between six and ten conductor loops around the tube tube             forms. A contact electrode may be made, for example             a glued to the tube tube in the contact area             Conductor wire exist. But is particularly advantageous             Embodiment in which the contact electrode (s) of a             applied to the Tubusrohraußenseite, electrically             conductive paint or a polymeric material formed             will / will, for example, directly on the tube tube             is injected.
  • Die Kontaktelektrode(n) ist/sind an mindestens einem am kranialen Ende des Tubusrohrs angeordneten Kontaktanschluss über mindestens eine am Tubusrohr entlang angeordnete Verbindungsleitung angeschlossen. Dabei kann die mindestens eine Verbindungsleitung ebenfalls aus elektrisch leitfähigem Lack oder angespritzten, elektrisch leitfähigen Polymermaterial gebildet sein. An dem Kontaktbereich kann dann nach dem Intubieren des Patienten eine Kontaktmanschette oder dgl. angelegt werden, die über Kabel an die Auswertelektronik angeschlossen wird, die dem Operateur die an den Stimmbändern des Patienten abgenommenen Antwortsignale auf die Nervenerregung anzeigt.The contact electrode (s) is / are on             at least one at the cranial end of the Tubusrohrs             arranged contact connection via at least one am             Tubusrohr along arranged connecting line             connected. The at least one             Connecting line also made of electrically conductive             Lacquer or molded, electrically conductive             Polymer material may be formed. At the contact area can             then after intubating the patient one             Contact sleeve or the like can be created, which is via cable             is connected to the evaluation electronics, the             Surgeon holding the vocal cords of the patient             indicates removed response signals to the nerve excitation.
  • Eine besonders universell einsetzbare Ausführungsform des erfindungsgemäßen Tubus erhält man, wenn das Tubusrohr im Kontaktbereich mit zwei Kontaktelektroden mit je zwei Elektrodenabschnitten versehen ist, wobei alle Elektrodenabschnitte den Kontaktbereich gleichläufig spiralförmig umschlingen und einander abwechselnd angeordnet sind. Bei einer derartigen, vierfachen Spiralanordnung liegen dann zweckmäßig der erste Elektrodenabschnitt der ersten Kontaktelektrode, der erste Elektrodenabschnitt der zweiten Kontaktelektrode, der zweite Elektrodenabschnitt der ersten Kontaktelektrode und der zweite Elektrodenabschnitt der zweiten Kontaktelektrode in dieser Reihenfolge nebeneinander. Die Elektrodenabschnitte der ersten Kontaktelektrode können dann am kranialen Ende des Kontaktbereiches miteinander verbunden sein und die Elektrodenabschnitte der zweiten Kontaktelektrode können am kaudalen Ende des Kontaktbereiches miteinander verbunden sein.A particularly universally applicable             Embodiment of the tube according to the invention is obtained,             if the Tubusrohr in the contact area with two             Contact electrodes each provided with two electrode sections             is, with all electrode sections the contact area             entwine spirally in the same direction and each other             are arranged alternately. In such a,             quadruple spiral arrangement are then suitably the first             Electrode portion of the first contact electrode, the first             Electrode portion of the second contact electrode, the             second electrode portion of the first contact electrode and             the second electrode portion of the second contact electrode             in this order next to each other. The             Electrode portions of the first contact electrode can             then at the cranial end of the contact area with each other             be connected and the electrode sections of the second             Contact electrode may be at the caudal end of the             Contact area to be interconnected.
  • Weitere Merkmale und Vorteile der Erfindung ergeben sich aus der nachfolgenden Beschreibung und der Zeichnung, worin eine bevorzugte Ausführungsform der Erfindung anhand eines Beispiels näher erläutert ist. Es zeigt:Further features and advantages of the invention             arise from the following description and the             Drawing, wherein a preferred embodiment of             Invention is explained in more detail with reference to an example. It shows:
  • Fig. 1 den Kopf eines mit einem erfindungsgemäßen Endotrachealtubus intubierten Patienten im Vertikalschnitt; 1 shows the head of a patient intubated with an endotracheal tube according to the invention in vertical section;
  • Fig. 2 den erfindungsgemäßen Tubus im gestreckten Zustand in einer Seitenansicht; 2 shows the tube according to the invention in the extended state in a side view.
  • Fig. 3 den Gegenstand der Fig. 2 im Schnitt längs der Linie III-III; Fig. 3 shows the subject of Figure 2 in section along the line III-III.
  • Fig. 4 eine Einzelheit IV des Tubus nach Fig. 2 in perspektivischer Darstellung. Fig. 4 shows a detail IV of the tube of FIG. 2 in a perspective view.
  • Der in Fig. 1 dargestellte Patient ist in bekannter Weise mit einem Endotrachealtubus 10 intubiert, der mit seinem kaudalen Ende 11 in die Luftröhre 12 des Patienten ragt und dort mittels einer über eine Ballonleitung 13 aufpumpbaren Blockmanschette 14 (cuff) gegenüber der Luftröhre 12 festgelegt und abgedichtet werden kann. Oberhalb der Blockmanschette 14 weist das Tubusrohr 15 des Tubus 10 einen Kontaktbereich 16 auf, der an den Stimmbändern 17 des Patienten anliegt, von denen in Fig. 1 nur eines zu sehen ist. Im Kontaktbereich 16 ist der Tubus 10 mit zwei Kontaktelektroden 18, 19 versehen, die Veränderungen in den elektrischen Aktionspotentialen der Stimmbänder messen können, an denen sie anliegen. Diese Änderungen der elektrischen Aktionspotentiale treten als Antwort einer Erregung des Nervus vagus, des Nervus laryngeus recurrens oder des Nervus laryngeus superior beim intraoperativen Neuromonitoring auf, von dem man bei Durchführung von Operationen im Halsbereich des Patienten Gebrauch macht, um den Nerv zu überwachen und nicht unbeabsichtigt zu schädigen.The patient shown in Fig. 1 is in             known manner intubated with an endotracheal tube 10,             with its caudal end 11 into the trachea 12 of the             Patient stands out and there by means of one over one             Balloon line 13 inflatable block cuff 14 (cuff)             set against the trachea 12 and sealed             can be. Above the block cuff 14 has the             Tubusrohr 15 of the tube 10 a contact area 16, the             attached to the vocal cords 17 of the patient, of which in             Fig. 1 only one can be seen. In the contact area 16 is             the tube 10 is provided with two contact electrodes 18, 19,             the changes in the electrical action potentials of the             Measuring vocal cords to which they rest. These             Changes in electrical action potentials occur as             Response of an excitement of the vagus nerve, the nerve             recurrent laryngeal nerve or the superior laryngeal nerve             Intraoperative neuromonitoring on, from which one at             Perform surgery in the neck area of the patient             Use to monitor the nerve and not             inadvertently damage.
  • Die Ausgestaltung der Kontaktelektroden 18, 19 im Kontaktbereich 16 des Tubus 10 ist Gegenstand der vorliegenden Erfindung; sie ist in den Fig. 2 bis 4 im Detail erkennbar. Danach weisen beide Kontaktelektroden 18, 19 mehrere Leiterschleifen 20 auf, die das Tubusrohr 15 im Kontaktbereich 16 spiralförmig umgeben. Die Anordnung ist so getroffen, dass die von der ersten Kontaktelektrode 18 gebildeten Leiterschleifen 20' immer zwischen den Leiterschleifen 20'' der zweiten Kontaktelektrode 19 liegen, sich mit diesen also abwechseln. Darüber hinaus bildet jede der beiden Kontaktelektroden 18, 19 jeweils einen ersten das Tubusrohr spiralförmig umgebenden Abschnitt 18a, 19a und einen zweiten das Tubusrohr spiralförmig umgebenden Abschnitt 18b, 19b, wobei auch die Leiterschleifen der beiden Elektrodenabschnitte einer jeden Kontaktelektrode einander abwechselnd nach Art einer Doppelhelix angeordnet sind und die insgesamt vier Elektrodenabschnitte 18a, 19a, 18b, 19b sich um jeweils 90° zueinander versetzt (Fig. 3) aufeinander folgend um den Kontaktbereich des Tubusrohres winden. Die beiden Elektrodenabschnitte 18a, 18b der ersten Kontaktelektrode sind am kranialen Ende 24 des Tubusrohres unmittelbar oberhalb der Blockmanschette 14 miteinander verbunden, während die Elektrodenabschnitte 19a, 19b der zweiten Kontaktelektrode 19 am kaudalen Ende 11 des Kontaktbereiches 16 zusammenlaufen.The embodiment of the contact electrodes 18,             19 in the contact region 16 of the tube 10 is the subject of             present invention; it is in Figs. 2 to 4 in             Detail recognizable. Thereafter, both contact electrodes             18, 19 a plurality of conductor loops 20, which the tube tube 15th             surrounded spirally in the contact region 16. The arrangement is             made such that the of the first contact electrode 18th             formed conductor loops 20 'always between the             Conductor loops 20 '' of the second contact electrode             19, so take turns with them. Furthermore             each of the two contact electrodes 18, 19 forms             a first surrounding the Tubusrohr spirally             Section 18a, 19a and a second the Tubusrohr             spirally surrounding portion 18b, 19b, wherein the             Conductor grinding the two electrode sections of a             each contact electrode alternately in the manner of a             Double helix are arranged and the four altogether             Electrode portions 18a, 19a, 18b, 19b around each             90 ° to each other (Fig. 3) successively order             Wind the contact area of the tube tube. The two             Electrode portions 18a, 18b of the first contact electrode             are directly at the cranial end 24 of the Tubusrohres             connected above the block cuff 14,             while the electrode portions 19a, 19b of the second             Contact electrode 19 at the caudal end 11 of the contact area             16 converge.
  • Vom kranialen Ende 24 des Kontaktbereiches 16 aus sind beide Kontaktelektroden 18, 19 über je eine Verbindungsleitung 21 bzw. 22, die außen entlang am Tubusrohr 15 verlaufen, an einem Kontaktanschluss 23 angeschlossen, an dem eine (nicht dargestellte) Kontaktmanschette mit Verbindungskabeln befestigt werden kann, um einen elektrisch leitenden Anschluss zu einer ebenfalls nicht dargestellten Auswerte- und Anzeigeeinrichtung für die von den Kontaktelektroden gemessenen Aktionspotentiale an den Stimmbandmuskeln herzustellen.From the cranial end 24 of the contact area             16 are both contact electrodes 18, 19 via one each             Connecting line 21 and 22, the outside along the             Tubus tube 15 extend at a contact terminal 23rd             connected to which a (not shown)             Contact collar to be fastened with connecting cables             can be used to make an electrically conductive connection to one             also not shown evaluation and             Display device for the of the contact electrodes             produce measured action potentials on the vocal cord muscles.
  • Sowohl die Kontaktelektroden als auch die diese mit dem Kontaktanschluss 23 verbindenden Verbindungsleitungen 21, 22 bestehen aus einem elektrisch leitfähigen, an der Oberfläche des Tubusrohrs bzw. dessen Kontaktbereiches angespritzten Polymermaterial, das eine ähnliche Flexibilität wie das Tubusrohr selbst aufweist und das dessen Verformungen mitmachen kann, ohne dabei beschädigt zu werden oder sich vom Tubusrohr abzulösen. Die elektrische Leitfähigkeit bzw. der spezifischen Widerstand des zum Einsatz kommenden Kontaktelektrodenmaterials ist durch Versuche bekannt und ändert sich durch die Verformungen, die der Tubus bei seiner Handhabung durchmacht, nicht, so dass die Signale infolge einer Änderung der elektrischen Aktionspotentiale am Stimmbandmuskel unverfälscht an die Anzeige- und Auswerteeinheit übermittelt werden.Both the contact electrodes and the             these connecting to the contact terminal 23             Connecting lines 21, 22 consist of an electric             conductive, on the surface of the Tubusrohrs or             Contact area of molded polymer material containing a             similar flexibility as the tube tube itself has             and that can go through its deformations without doing so             to be damaged or to detach from the tube tube. The             electrical conductivity or resistivity             is used for coming contact electrode material             known by experiments and changes through the             Deformations that the tube in its handling             does not go through, so the signals as a result of a             Change of electrical action potentials at             Unadulterated vocal cord muscle to the display and             Evaluation unit to be transmitted.
  • Bei dem dargestellten, bevorzugten Ausführungsbeispiel des erfindungsgemäßen Endotrachealtubus hat der Kontaktbereich 16 eine Länge von etwa 60 mm, wobei jeder Kontaktelektrodenabschnitt jeweils acht Leiterschleifen 20 bildet, die den Kontaktbereich umschlingen. Aufgrund der Vielzahl möglicher Kontaktstellen mit den Stimmbändern, die sich über die Länge des Kontaktbereiches ergeben, ist ein zuverlässiger Kontakt zwischen den Kontaktelektroden und den Stimmbandmuskeln immer gewährleistet. Da der Kontaktbereich über seinen gesamten Umfang mit den Leiterschleifen der Kontaktelektroden versehen ist, kann auch ein Verdrehen des Tubus in der Luftröhre nicht dazu führen, dass das Tubusrohr mit einem Bereich an den Stimmbändern anliegt, an denen sich keine Kontaktelektroden befinden, was bei bislang bekannten Endotrachealtuben, die beim intraoperativen Neuromonitoring zum Einsatz kamen, ein mögliches Problem bei der Zuverlässigkeit des Monitoring darstellte.In the illustrated, preferred             Embodiment of the invention             Endotracheal tube, the contact region 16 has a length of             about 60 mm, each contact electrode section respectively             eight conductor loops 20 forms the contact area             entwine. Due to the large number of possible             Contact points with the vocal cords that run the length             of the contact area is a reliable contact             between the contact electrodes and the vocal cord muscles             always guaranteed. Since the contact area over his             entire circumference with the conductor loops of             Contact electrodes is provided, can also be a twisting of the             Tubus in the trachea does not cause that             Tubus tube with a portion of the vocal cords,             where there are no contact electrodes, what with             previously known endotracheal tubes, the             intraoperative neuromonitoring were used             posed a potential problem with the reliability of the monitoring.
  • Die Erfindung ist nicht auf das dargestellte und beschriebene Ausführungsbeispiel beschränkt, sondern es sind verschiedene Änderungen und Ergänzungen denkbar, ohne den Rahmen der Erfindung zu verlassen. Beispielsweise ist es nicht zwingend erforderlich, dass die Kontaktelektroden das Tubusrohr im Kontaktbereich spiralförmig umschließen, auch wenn dies insbesondere bei der vorstehend beschriebenen und dargestellten bipolaren Anordnung von Kontaktelektroden besonders vorteilhaft ist. Insbesondere wenn eine monopolare Kontaktelektrode zum Einsatz kommt, ist es denkbar, die Leiterschleifen als in sich geschlossene, den Kontaktbereich ringförmig umgebende Gestaltung auszubilden, die dann alle über eine gemeinsame, axial verlaufende Verbindungsleitung, die an der Außenseite des Tubusrohrs bis hin zur Blockmanschette verläuft, in Kontakt mit dem Kontaktanschluss gebracht werden. Eine vergleichbare Gestaltung lässt sich auch für bipolare Elektroden realisieren, wenn die ringförmig angelegten Leiterschleifen nicht umlaufend geschlossen, sondern an einer Stelle unterbrochen sind, durch die hindurch dann die Verbindungsleitung der jeweils anderen Kontaktelektrode durchlaufen kann, ohne dass es zu einem Kurzschluss mit der ersten Elektrode kommt. Natürlich kann die Erfindung nicht nur beim kontinuierlichen Neuromonitoring zum Einsatz kommen, sondern lässt sich auch in Fällen einsetzen, bei denen der zu überwachende Nerv manuell stimuliert wird.The invention is not on the             illustrated and described embodiment             limited, but there are different changes and             Supplements conceivable, without the scope of the invention             leave. For example, it is not mandatory             required that the contact electrodes in the Tubusrohr             Wrap the contact area in a spiral, even if this is the case             in particular in the case of the above-described and             illustrated bipolar arrangement of contact electrodes             is particularly advantageous. Especially if one             monopolar contact electrode is used, it is             conceivable, the conductor loops as self-contained, the             Contact area annularly surrounding design             then train all over a common, axial             extending connecting line, which is on the outside of the             Tubusrohrs runs up to the block cuff, in             Contact with the contact terminal are brought. A             comparable design can also be used for bipolar             Realize electrodes when the annular applied             Conductor loops not circumferentially closed, but on             a place are interrupted, through which then             the connecting line of the other contact electrode             can go through without causing a short circuit with             the first electrode comes. Of course, the invention             not only for continuous neuromonitoring             but can also be used in cases where             where the nerve to be monitored is manually stimulated.

Claims (11)

1. Endotrachealtubus mit einem Tubusrohr und mindestens einer Kontaktelektrode zur Anlage an mindestens einem Stimmband eines mit dem Tubus intubierten Patienten, dadurch gekennzeichnet, dass die Kontaktelektrode (18; 19) mindestens eine das Tubusrohr (15) in einem Kontaktbereich (16) wenigstens annähernd umlaufend umgebende Leiterschleife (20) aufweist.1. Endotracheal tube with a tube tube and at least one contact electrode for engaging at least one vocal cord of a patient intubated with the tube, characterized in that the contact electrode (18; 19) at least one tube tube (15) in a contact region (16) at least approximately encircling having surrounding conductor loop (20).
2. Tubus nach Anspruch 1, dadurch gekennzeichnet, dass die Kontaktelektrode (18; 19) mehrere Leiterschleifen (20) aufweist, die das Tubusrohr (15) im Kontaktbereich (16) ring- oder spiralförmig umgeben.2. Tubus according to claim 1, characterized in that the contact electrode (18; 19) has a plurality of conductor loops (20) which surround the tube tube (15) in the contact region (16) annularly or spirally.
3. Tubus nach Anspruch 1 oder 2, dadurch gekennzeichnet, dass mehrere, insbesondere zwei Kontaktelektroden (18; 19) vorgesehen sind, deren Leiterschleifen (20', 20'') einander abwechselnd am Kontaktbereich (16) des Tubusrohrs (15) angeordnet sind.3. Tubus according to claim 1 or 2, characterized in that a plurality, in particular two contact electrodes (18; 19) are provided, whose conductor loops (20 ', 20'') are arranged alternately on the contact region (16) of the Tubusrohrs (15) ,
4. Tubus nach Anspruch 3, dadurch gekennzeichnet, dass die Kontaktelektroden (18; 19) unterschiedliche Polaritäten haben und mindestens eine bipolare Elektrode bilden.4. A tube according to claim 3, characterized in that the contact electrodes (18; 19) have different polarities and form at least one bipolar electrode.
5. Tubus nach einem der Ansprüche 1 bis 4, dadurch gekennzeichnet, dass jede Kontaktelektrode (18; 19) einen ersten das Tubusrohr (15) im Kontaktbereich (16) spiralförmig umgebenden Abschnitt (18a; 19a) und einen zweiten das Tubusrohr (15) im Kontaktbereich (16) spiralförmig umgebenden Abschnitt (18b; 19b) aufweist, wobei die Leiterschleifen (20) der beiden Elektrodenabschnitte (18a, b; 19a, b) einander abwechselnd nach Art einer Doppelhelix angeordnet sind.5. Tubus according to one of claims 1 to 4, characterized in that each contact electrode (18; 19) has a first tubular tube (15) in the contact region (16) spirally surrounding portion (18 a, 19 a) and a second tube tube (15) in the contact region (16) spirally surrounding portion (18b, 19b), wherein the conductor loops (20) of the two electrode sections (18a, b, 19a, b) are arranged alternately in the manner of a double helix.
6. Tubus nach Anspruch 5, dadurch gekennzeichnet, dass die beiden Elektrodenabschnitte (18a, b) an einem kaudalen Ende (11) des Kontaktbereiches (16) miteinander verbunden sind.6. Tubus according to claim 5, characterized in that the two electrode sections (18a, b) at a caudal end (11) of the contact region (16) are interconnected.
7. Tubus nach einem der Ansprüche 1 bis 6, dadurch gekennzeichnet, dass der Kontaktbereich (16) eine Länge zwischen etwa 40 mm und 80 mm, bevorzugt zwischen 50 mm und 70 mm hat und dass jede Kontaktelektrode oder jeder Elektrodenabschnitt (18a, b; 19a, b) über die Länge der Kontaktfläche (16) zwischen vier und zwölf Leiterschleifen (20), vorzugsweise zwischen sechs und zehn Leiterschleifen um das Tubusrohr (15) bildet.7. Tube according to one of claims 1 to 6, characterized in that the contact region (16) has a length between about 40 mm and 80 mm, preferably between 50 mm and 70 mm, and that each contact electrode or each electrode portion (18a, b; 19a, b) over the length of the contact surface (16) between four and twelve conductor loops (20), preferably between six and ten conductor loops around the tube tube (15).
8. Tubus nach einem der Ansprüche 1 bis 7, dadurch gekennzeichnet, dass die Kontaktelektrode(n) (18; 19) von einem an der Tubusrohraußenseite aufgetragenen, elektrisch leitfähigen Lack oder Polymermaterial gebildet wird/werden.8. Tubus according to one of claims 1 to 7, characterized in that the contact electrode (s) (18; 19) is formed by an applied to the Tubusrohraußenseite, electrically conductive paint or polymer material / are.
9. Tubus nach einem der Ansprüche 1 bis 8, dadurch gekennzeichnet, dass die Kontaktelektrode(n) (18; 19) an mindestens einen am kranialen Ende des Tubusrohrs (15) angeordneten Kontaktanschluss (23) über mindestens eine am Tubusrohr (15) entlang angeordnete Verbindungsleitung (21, 22) angeschlossen ist/sind.9. Tube according to one of claims 1 to 8, characterized in that the contact electrode (s) (18; 19) arranged on at least one at the cranial end of Tubusrohrs (15) contact terminal (23) via at least one of the tube tube (15) along arranged connecting line (21, 22) is connected / are.
10. Tubus nach einem der Ansprüche 1 bis 9, dadurch gekennzeichnet, dass das Tubusrohr (15) im Kontaktbereich (16) mit zwei Kontaktelektroden (18, 19) mit je zwei Elektrodenabschnitten (18a, b; 19a, b) versehen ist, wobei alle Elektrodenabschnitte den Kontaktbereich gleichläufig spiralförmig umschlingen und einander abwechselnd angeordnet sind.10. Tube according to one of claims 1 to 9, characterized in that the Tubusrohr (15) in the contact region (16) with two contact electrodes (18, 19), each with two electrode sections (18a, b, 19a, b) is provided all electrode sections loop around the contact area in the same direction and are arranged alternately.
11. Tubus nach Anspruch 10, dadurch gekennzeichnet, dass die Elektrodenabschnitte (18a, b) der ersten Kontaktelektrode (18) am kaudalen Ende (11) des Kontaktbereiches (16) miteinander verbunden sind und die Elektrodenabschnitte (19a, b) der zweiten Kontaktelektrode (19) am kranialen Ende des Kontaktbereiches (16) miteinander verbunden sind.11. A tube according to claim 10, characterized in that the electrode sections (18a, b) of the first contact electrode (18) at the caudal end (11) of the contact region (16) are interconnected and the electrode portions (19a, b) of the second contact electrode (18 19) are connected together at the cranial end of the contact area (16).
EP11713085A 2010-03-23 2011-03-14 Endotracheal tube Withdrawn EP2549921A1 (en)

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DE102010016076A DE102010016076A1 (en) 2010-03-23 2010-03-23 endotracheal tube
PCT/IB2011/051057 WO2011117773A1 (en) 2010-03-23 2011-03-14 Endotracheal tube

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US20130006083A1 (en) 2013-01-03
US8712496B2 (en) 2014-04-29
WO2011117773A1 (en) 2011-09-29

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