WO1999006087A1 - Anlage und verfahren zur regelung des flüssigkeitshaushaltes von patienten - Google Patents
Anlage und verfahren zur regelung des flüssigkeitshaushaltes von patienten Download PDFInfo
- Publication number
- WO1999006087A1 WO1999006087A1 PCT/AT1998/000181 AT9800181W WO9906087A1 WO 1999006087 A1 WO1999006087 A1 WO 1999006087A1 AT 9800181 W AT9800181 W AT 9800181W WO 9906087 A1 WO9906087 A1 WO 9906087A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- patient
- liquid
- fluid
- control
- water
- Prior art date
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Classifications
-
- 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
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
- A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
- A61M5/172—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic
- A61M5/1723—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body electrical or electronic using feedback of body parameters, e.g. blood-sugar, pressure
-
- 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
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
- A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
- A61M5/16877—Adjusting flow; Devices for setting a flow rate
-
- 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
- A61M5/00—Devices for bringing media into the body in a subcutaneous, intra-vascular or intramuscular way; Accessories therefor, e.g. filling or cleaning devices, arm-rests
- A61M5/14—Infusion devices, e.g. infusing by gravity; Blood infusion; Accessories therefor
- A61M5/168—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body
- A61M5/16886—Means for controlling media flow to the body or for metering media to the body, e.g. drip meters, counters ; Monitoring media flow to the body for measuring fluid flow rate, i.e. flowmeters
Definitions
- the invention relates to a system and a method for balancing the fluid balance of a patient, as described in the preambles of claims 1 and 13.
- the balance of a patient's fluid balance is the ratio of the absorbed to the excreted amount of fluid per unit of time.
- the balancing of the water-electrolyte balance as an intensive therapeutic measure serves to maintain a balanced water-electrolyte balance (maintenance of homeostasis) and the restoration of the water-electrolyte balance in the event of disturbances (restoration of homeostasis). It is balanced when the content and distribution of water and electrolytes in the extracellular and intracellular space meet the physiological requirements.
- balancing means calculating the amount of water to be supplied parenterally or enterally in order to achieve these objectives.
- the sodium and potassium requirement or consumption can, but does not have to be included in this accounting.
- the accounting calculation shows as a basic requirement a maintenance requirement for maintaining homeostasis in the individual case of illness and, if necessary, a replacement requirement for abnormal losses and a correction requirement for restoring homeostasis by correcting disruptions that have occurred.
- the total requirement results from the basic requirement, replacement requirement and correction requirement.
- the amount of liquid delivered or supplied is measured by reading these values, usually only once a day, on the corresponding devices.
- the object of the present invention is to develop a system and a method ren to balance the fluid balance of a patient to create, which allows an adjustment of the target values of the liquid to be supplied to the actual state of the patient.
- the return to the target value can start as early as possible and thus, even in the event of short-term strong changes, a difference between the target and actual values in the fluid balance in that area can be kept, which avoid life threatening the patient.
- Stand for example the liquid level in devices for supplying the liquids or the monitoring of the maximum fill level of containers for holding secreted liquids can be easily monitored and the reduction of the liquid requirement operating conditions which have a lasting influence can be avoided with certainty.
- Sweat secretion excreted by the patient can easily be included in the overall calculation and fluid balance. It is also advantageous to further develop the system according to claim 5, since the sweating can be included automatically and adapted to the ongoing changes in the system for balancing the fluid balance.
- the embodiment variant according to claim 7 makes it possible to determine the various elements or the liquid which are to be monitored by the system, as a result of which the system can be used universally.
- the embodiment variant according to claim 1 1 or 12 enables, in addition to rapid processing and analysis of an abundance of at least partially constantly changing actual data, also a computational determination of additional amounts of liquid that are released or released, which also means processes that not technically or only with extreme effort, could be included in the calculation using a simulation.
- the invention also includes the method for regulating the fluid balance of a patient, which is defined by the features in the characterizing part of claim 13. It is advantageous with this method that additional quantities of liquid that cannot be detected by real-time measured values are included in the calculation, and the accuracy of the determination of the liquid balance can thus be increased.
- FIG. 1 shows a system according to the invention in the form of a block diagram in a simplified, schematic representation
- Fig. 3 is a block diagram of the control or regulating device in a simplified, schematic representation.
- the balance of the fluid balance is indicated in all disease states in which homeostasis is threatened or the water-electrolyte balance is already disturbed. It is therefore indicated for all acute, serious diseases, traumas and operations in which the physiological absorption, elimination and regulation mechanisms of the water-electrolyte balance are impaired to such an extent that serious disturbances in the water-electrolyte balance occur are or threaten to occur.
- the balancing is still indicated for parenteral and completely artificial enteral nutrition as well as for forced diuresis.
- the pathophysiological relationships are extremely complex. Unpredictable volume problems can occur at any time and relatively small over or under balancing can lead to threatening circulatory instability or a decrease in the art. real oxygen saturation.
- a disturbance in the normal elimination of water and electrolytes can lead to surpluses even when a normal requirement is supplied.
- Typical examples are oligo-only kidney failure, heart failure and liver failure, as well as illnesses due to a lack of antidiuretic hormone (ADH), in which the body excretes many liters of hypotonic urine every day.
- ADH antidiuretic hormone
- the balancing is based on the knowledge that the normal requirement (basic requirement) corresponds to the pathophysiology of the basic suffering for an adapted basic requirement based on the balance of a previous defined period of time to replace abnormal losses and taking into account the current state of the water-electrolyte balance at the time of the balancing , that is, a need for correction in the event of faults is corrected or adapted.
- the normal requirement describes the basic requirement as the average ongoing maintenance requirement under normal resting conditions with proper kidney function and an intact water-electrolyte balance.
- the supply of the average maintenance amounts guarantees maintenance of homeostasis only if there are no disturbances in the water-electrolyte balance and there are no abnormal losses or illness-related excretion disorders.
- the basic needs must be adapted to the basic condition, supplemented by a need for replacement and corrected by a need for correction.
- the basic requirements are therefore corrected and supplemented on the basis of the pathophysiology of the basic condition, the balance of the previous period and the assessment of the current situation of the water-electrolyte balance.
- the pathophysiology of basic suffering can force an adaptation of the normal basic needs to the special conditions of basic suffering. This is the case if there is a disturbance in the renal excretion of sodium, water or potassium, e.g. in case of heart or kidney insufficiency with the necessary sodium and water rejection.
- FIG. 1 shows an arrangement 1 according to the invention, which comprises a control or regulating device 2 with a monitoring device 3, for example a personal computer 4, and injectomats or infusion pumps 5 and 6. These are over Implementation components 7, for example bus controllers connected to a bus system 8.
- Devices 9 for receiving liquids, for example a urimeter 10, a thoracic drainage device 11, are also connected to the control and regulating device 2 via this bus system 8.
- the infusion pumps 5, 6, the urimeter 10, the thoracic drainage device 11 and optionally devices 12 for dispensing amounts of liquid, for example a glucose and / or Ringer infusion 13, 14 and / or an INCA-ST 15, are connected to one via lines 16 to 21 Patient 22 connected.
- Flow rate measuring devices 23 to 28 are arranged between the patient 22 and the lines 16 to 21. These are e.g. Connected to the control or regulating device 2 via conversion components 7, so-called network or bus controllers 29 with a bus system 30 or individual lines 31. For the sake of simplicity, only a single line 31 is shown in broken lines in FIG. 1.
- the creation of the balance of body fluids is based on the monitoring and calculation of the supply and discharge of fluids. Enteral and parenteral intake and absorption from inhalation aerosols must be taken into account during the administration.
- the endogenous body water can be fed into a memory of the control and regulating device as a constant value, which is calculated from empirical values depending on the body weight of the patient.
- the amount of water generated by the combustion of carbohydrates, protein and fat from food or the body's own tissue in the intermediate metabolism, namely the oxidation water and the metabolic water, is given in adults as 200 mg to 300 mg per 24 hours or 270 ml / m 2 of body surface and day . It depends on the energy consumption and is usually 10 ml / 100 kcal to 15 ml / 100 kcal (2.4 ml / 100 kJ to 3.6 ml / 100 kJ), but can increase considerably in hypercatabolic conditions.
- the control or regulating device 2 is provided with input elements 32 to 35 with which the metabolic water, the amount of endogenous metabolic water and / or the energy consumption can be adjusted.
- the alveolar absorption from aerosols can be 300 ml to 500 ml every 24 hours and is determined with the flow rate measuring device 28.
- the amount of water given off by patient 22 is composed of urine, perspirit insensitivity, sweat, stool and secretions from the digestive tract.
- the renal excretion of water via the urine can be measured precisely via the flow rate measuring device 24 and that of sodium and potassium via the urimeter 10.
- concentration of sodium or potassium is not of decisive importance for the liquid balance, but these values can thus be made available to the attending physician for therapeutic purposes in a simple manner.
- Loss of fluid through perspiratio insensibilis is a function of the body's heat release and depends on the energy turnover. It is 10.0 ml / kJ to 10.5 ml / kJ and, as an obligatory water loss, is largely independent of the external water balance and can be preset via an adjusting element 36, which, if desired, can be arranged.
- the pulmonary portion of the fluid delivery by perspiration is normally about 400 ml per 24 hours and can be taken into account via an adjusting member 37 if necessary.
- the artificial moistening of the air we breathe can reduce the loss of pulmonary fluid.
- the balance can be balanced or even positive. However, this can be determined in a control and / or regulating device by querying the flow rate measuring device 28 and corrected as a whole.
- extra-glandular water release which, for example, can be 800 ml to 1200 ml in 24 hours for an adult, namely about 480 ml / m 2 to 550 ml / m 2 body surface area and 12 ml / kg to 15 ml / kg body weight and is taken into account by the adjusting member 37.
- the loss of fluid due to Perspiratio sensibilis begins when the indifference temperature is exceeded.
- the sweat secretion of an adult is 300 ml in 24 hours with slight, occasional sweating, 600 ml with moderate, occasional sweating, 1000 ml with heavy, occasional sweating or 2000 ml to 15000 ml with continuous sweating.
- the water content of the chair is given as approx. 70% to 80%.
- measurement is possible with a measuring device 40, but can be omitted in view of whether this is necessary at all for the achievable accuracy limit of the balancing, especially with regard to the considerable hygienic problems.
- gastrointestinal water and electrolyte losses can take on a considerable extent.
- the excretion of body secretions, exudates and transudates can be measured precisely if these are derived through probes, drainage or fistulas.
- Fistula secretions can also be collected using plastic bags 41 fixed to the abdominal wall.
- the amount of water can be determined via flow rate measuring devices 42, 43, preferably as a function of the time that can be arranged upstream of the plastic bag 41 or a suction device 44.
- the electrolyte content of the secretions collected can be measured.
- Reference values for the average electrolyte content of body juices are available in the form of tables, which can also be entered and stored in the control or regulating device 2 or in its storage units 47 via input elements 45 or data carriers 46.
- the automatic enteral supply via injectomats and infusion pumps is recorded and monitored via the networking of these via a gateway suitable for use on the patient 22, for example Adcon H per patient 22.
- a gateway suitable for use on the patient 22, for example Adcon H per patient 22.
- input options can be provided by the operating personnel, for example via barcode readers, patient identity cards, in particular for recording the type and amount of the medication to be administered. elements should be provided. All data is fed into the network and is available to doctors and operating personnel both administratively and graphically.
- control and / or regulating device is not restricted to a specific embodiment.
- This can be any electronic control, for example the control currently corresponding to the term "self-programmable control” or a microprocessor control specially developed for this purpose.
- the transmission of the measured values recorded with the input devices 32 to 35, 38, 39, 45 can also be carried out separately for each input device directly to the control device. It is also possible to use a bus system 48 for data transmission between the input elements 32 to 35, 38, 39, 45 and the control device 2.
- each of the flow rate measuring devices 23 to 28 or the urimeter 10 the thoracic drainage device 11, the glucose infusion 13 and any other devices for the liquid supply or disposal of patients 22 Transfer components 7, which can form corresponding interfaces, are connected to the control or regulating device 2.
- the input members 32 to 35, 36, 37, 38, 39, 45 can also be operated by the operating personnel using manually operated elements, such as sliders, rotary knobs or the like, or by using barcode readers 49 or patient identity cards 50, whereby for the different types and amounts of the medication to be administered, the respective amount of liquid is automatically determined, and also for the input variables mentioned above, such as loss of fluid due to sweating or delivery via the body surface with data from table 51, with barcode readers 49 can be read in or a hand terminal 52 can be entered.
- manually operated elements such as sliders, rotary knobs or the like
- barcode readers 49 or patient identity cards 50 whereby for the different types and amounts of the medication to be administered, the respective amount of liquid is automatically determined, and also for the input variables mentioned above, such as loss of fluid due to sweating or delivery via the body surface with data from table 51, with barcode readers 49 can be read in or a hand terminal 52 can be entered.
- the medium does not have to be translucent in every case and the introduction of foreign substances in order to enable a measurement of the flow rate is not necessary.
- the transit time measurement can be carried out by means of two measurement sensors which are arranged one behind the other and record the special properties of the fluid particles.
- Detection element with which the cross-section of the conductor can be continuously monitored or pre-entered and, above all, the flow direction and the degree of filling are monitored over the cross-sectional area.
- the flow rate measuring device 23 to 28 is preferably integrated in a holder designed as a clip, which can be clamped onto the corresponding line 16 to 21.
- the urine excretion can be measured by a urimeter 10, and that of the tracheobronchial secretion can be measured by chest drain devices 11.
- CCD sensors 55 which are “charged coupled divide” sensors, can also be used to detect and determine the cross-section of the lines 16 to 21 or the degree of filling over the cross-sectional areas.
- CCD sensors are used, it is advantageous to arrange or design them in the immediate measuring range of the flow rate measuring device 23 to 28 or as a component thereof.
- control or regulating device 2 it is also possible for the control or regulating device 2 to be assigned an input element for a resorption factor or a resorption quantity from inhalation aerosols and actual value inputs and / or storage units 47 and / or endogenous metabolic water in the control or regulating device 2 are arranged.
- 2 shows another embodiment variant of the system according to the invention. To simplify the illustration, only one device 9 for receiving or device 12 for dispensing quantities of liquid is shown. However, this does not imply that further devices 9 or 12 may not be present in the overall system.
- the control or regulating device 2, to which in turn a monitoring device 3 can be connected takes over the monitoring or regulation of the amounts of liquid delivered or received by the patient 22. Extraordinary amounts of liquid, such as injections, can also be recorded in the balance sheet.
- the amount of liquid contained in a syringe 56 is injected into a device 57 and from there it is fed to the patient 22 via known delivery devices.
- the quantity can be recorded manually on the one hand by the operating personnel via an input device 58 or optionally via a flow rate measuring device 59.
- the values recorded in this way are made available to the control or regulating device 2 and incorporated into the balance sheet by means of appropriate software.
- the flow rate measuring devices 59 to 61 are designed as clips and can thus be attached to the hose lines 62 to 64 in a simple manner.
- the respective cross section of the hose lines 62 to 64 can be determined with the aid of CCD sensors 55.
- the direction of flow and objects found in extremely dirty liquids can be measured.
- the flow rate is determined via a measuring section 65 by a two-point measurement. Any inhomogeneities that may occur, such as air bubbles, are also detected.
- Fig. 3 is a block diagram of the Steuer designated. Control device 2 shown.
- the amounts of fluid drained of urine 66, preparation insensibilis 67, sweat 68, stool 69, digestive tract secretion 70, tracheobronchial secretion 71 as well as exudate 72 and transudate 73 from wounds or in body cavities and the amounts of liquid supplied are determined by enteral and parenteral supply 74, 75, endogenous body water 76 and absorption from inhalation aerosols 77, provided these amounts of liquid are present.
- a replacement requirement is calculated from the discharged and supplied quantities of liquid, which together with the normal requirement results in the basic requirement.
- an adapted basic requirement can be calculated.
- the basic requirement or the adapted basic requirement can be combined balance a total requirement with a need for correction, which results from the newly determined discharged and supplied amounts of fluid 66 to 77, which is subsequently of importance for the fluid balance of a patient.
Abstract
Description
Claims
Priority Applications (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19881048T DE19881048D2 (de) | 1997-08-01 | 1998-07-30 | Anlage und Verfahren zur Regelung des Flüssigkeitshaushaltes von Patienten |
AU86161/98A AU8616198A (en) | 1997-08-01 | 1998-07-30 | Installation and device for regulating fluid equilibrium in patients |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
ATA1306/97 | 1997-08-01 | ||
AT130697 | 1997-08-01 |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1999006087A1 true WO1999006087A1 (de) | 1999-02-11 |
Family
ID=3511042
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/AT1998/000181 WO1999006087A1 (de) | 1997-08-01 | 1998-07-30 | Anlage und verfahren zur regelung des flüssigkeitshaushaltes von patienten |
Country Status (3)
Country | Link |
---|---|
AU (1) | AU8616198A (de) |
DE (1) | DE19881048D2 (de) |
WO (1) | WO1999006087A1 (de) |
Cited By (7)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE10011395A1 (de) * | 2000-03-09 | 2001-09-20 | Braun Melsungen Ag | Fluid-Bilanzierungssystem |
EP1804889A2 (de) * | 2004-09-09 | 2007-07-11 | PLC Medical Systems, Inc. | Patienten-hydratationssystem und verfahren |
US8007460B2 (en) | 2004-09-09 | 2011-08-30 | Plc Medical Systems, Inc. | Patient hydration system and method |
EP2382004A1 (de) * | 2009-01-28 | 2011-11-02 | PLC Medical Systems, Inc. | Flüssigkeitsaustauschvorrichtung |
US8075513B2 (en) | 2006-10-13 | 2011-12-13 | Plc Medical Systems, Inc. | Patient connection system for a balance hydration unit |
US10639419B2 (en) | 2014-03-17 | 2020-05-05 | Plc Medical Systems, Inc. | Fluid therapy method |
US11213621B2 (en) | 2004-09-09 | 2022-01-04 | Reprieve Cardiovascular, Inc. | Fluid therapy method |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4291692A (en) * | 1979-10-09 | 1981-09-29 | University Of Utah | Closed-loop infusion system, both method and apparatus, based on real time urine measurement |
US4449538A (en) * | 1982-01-25 | 1984-05-22 | John Corbitt | Medical-electronic body fluid accounting system |
EP0421625A1 (de) * | 1989-09-14 | 1991-04-10 | Suzuken Co. Ltd. | Vorrichtung zur stetigen Messung der lokalen Schweissflussgeschwindigkeit der Haut |
US5423747A (en) * | 1993-01-22 | 1995-06-13 | Terumo Kabushiki Kaisha | Medical pump drive |
US5590648A (en) * | 1992-11-30 | 1997-01-07 | Tremont Medical | Personal health care system |
-
1998
- 1998-07-30 WO PCT/AT1998/000181 patent/WO1999006087A1/de active Application Filing
- 1998-07-30 DE DE19881048T patent/DE19881048D2/de not_active Expired - Lifetime
- 1998-07-30 AU AU86161/98A patent/AU8616198A/en not_active Withdrawn
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4291692A (en) * | 1979-10-09 | 1981-09-29 | University Of Utah | Closed-loop infusion system, both method and apparatus, based on real time urine measurement |
US4449538A (en) * | 1982-01-25 | 1984-05-22 | John Corbitt | Medical-electronic body fluid accounting system |
EP0421625A1 (de) * | 1989-09-14 | 1991-04-10 | Suzuken Co. Ltd. | Vorrichtung zur stetigen Messung der lokalen Schweissflussgeschwindigkeit der Haut |
US5590648A (en) * | 1992-11-30 | 1997-01-07 | Tremont Medical | Personal health care system |
US5423747A (en) * | 1993-01-22 | 1995-06-13 | Terumo Kabushiki Kaisha | Medical pump drive |
Cited By (14)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
DE10011395A1 (de) * | 2000-03-09 | 2001-09-20 | Braun Melsungen Ag | Fluid-Bilanzierungssystem |
US8444623B2 (en) | 2004-09-09 | 2013-05-21 | Plc Medical Systems, Inc. | Patient hydration method |
EP1804889A4 (de) * | 2004-09-09 | 2010-07-28 | Plc Medical Systems Inc | Patienten-hydratationssystem und verfahren |
US8007460B2 (en) | 2004-09-09 | 2011-08-30 | Plc Medical Systems, Inc. | Patient hydration system and method |
EP1804889A2 (de) * | 2004-09-09 | 2007-07-11 | PLC Medical Systems, Inc. | Patienten-hydratationssystem und verfahren |
US9526833B2 (en) | 2004-09-09 | 2016-12-27 | Plc Medical Systems, Inc. | Patient hydration system with bolus function |
US11213621B2 (en) | 2004-09-09 | 2022-01-04 | Reprieve Cardiovascular, Inc. | Fluid therapy method |
US8075513B2 (en) | 2006-10-13 | 2011-12-13 | Plc Medical Systems, Inc. | Patient connection system for a balance hydration unit |
EP2382004A1 (de) * | 2009-01-28 | 2011-11-02 | PLC Medical Systems, Inc. | Flüssigkeitsaustauschvorrichtung |
EP2382004A4 (de) * | 2009-01-28 | 2013-08-21 | Plc Medical Systems Inc | Flüssigkeitsaustauschvorrichtung |
US10045734B2 (en) | 2009-01-28 | 2018-08-14 | Plc Medical Systems, Inc. | Fluid replacement device |
US11064939B2 (en) | 2009-01-28 | 2021-07-20 | Reprieve Cardiovascular, Inc. | Fluid replacement device |
US10639419B2 (en) | 2014-03-17 | 2020-05-05 | Plc Medical Systems, Inc. | Fluid therapy method |
US11696985B2 (en) | 2014-03-17 | 2023-07-11 | Reprieve Cardiovascular, Inc. | Fluid therapy method |
Also Published As
Publication number | Publication date |
---|---|
AU8616198A (en) | 1999-02-22 |
DE19881048D2 (de) | 2001-02-22 |
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