WO2007085625A1 - Dispositif de reglage et de commande de la pression dans des manchettes de canules endotracheales ou de tracheostomie - Google Patents

Dispositif de reglage et de commande de la pression dans des manchettes de canules endotracheales ou de tracheostomie Download PDF

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Publication number
WO2007085625A1
WO2007085625A1 PCT/EP2007/050709 EP2007050709W WO2007085625A1 WO 2007085625 A1 WO2007085625 A1 WO 2007085625A1 EP 2007050709 W EP2007050709 W EP 2007050709W WO 2007085625 A1 WO2007085625 A1 WO 2007085625A1
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WO
WIPO (PCT)
Prior art keywords
pressure
connection
cuff
volume
valve
Prior art date
Application number
PCT/EP2007/050709
Other languages
German (de)
English (en)
Inventor
Ralf Schnell
Original Assignee
Tracoe 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 Tracoe Medical Gmbh filed Critical Tracoe Medical Gmbh
Publication of WO2007085625A1 publication Critical patent/WO2007085625A1/fr

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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
    • 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
    • A61M16/044—External cuff pressure control or supply, e.g. synchronisation with respiration
    • 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
    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/07—General characteristics of the apparatus having air pumping means
    • A61M2205/071—General characteristics of the apparatus having air pumping means hand operated
    • A61M2205/073—Syringe, piston type

Definitions

  • the present invention relates to a device for adjusting and controlling the pressure in cuffs of endotracheal or tracheostomy tubes, comprising a pressure gauge and a pressure build-up device connectable to the pressure gauge, and a connection for connecting the pressure-building device to a cuff filling hose.
  • Corresponding devices have long been known and used, especially in intensive care, when patients must be artificially ventilated.
  • endotracheal tubes or tracheostomy tubes with cuffs, preferably low pressure cuffs are used for artificial ventilation of patients.
  • the patient is supplied with the breathing air through the tube.
  • the cuff located on the outside of the tube has the function of sealing the tube with respect to the trachea.
  • cuff pressure In order to ensure the sealing function through the cuff, one typically requires a minimum pressure of 15 mbar. The highest, longer-term cuff pressure should not exceed 25 to 30 mbar. At cuff pressures above approximately 25 to 30 mbar, the perfusion of the tracheal mucous membrane is suppressed and mucosal necrosis occurs, which leads to the formation of ulcers and, in extreme cases, to deep necrosis, in which the cricoid cartilage can be destroyed. According to the current state of medicine, it is agreed that the risk of such pressure necrosis can be significantly reduced by consistent monitoring of the cuff pressure. Therefore, it is recommended that the cuff pressure in mechanically ventilated patients be checked several times a day and corrected if necessary.
  • the cuff pressure is generally controlled with a commercial hand-held pressure gauge.
  • a pneumatic connection between the male luer fitting of the handheld manometer and the female luer fitting of the one-way valve of the control balloon of the endotracheal tube or the tracheostomy cannula is made.
  • a pressure equalization between the low-pressure cuff and the manometer takes place in that a small amount of air from the cuff on the filling hose, the control balloon and the one-way valve into the pressure gauge.
  • This causes a pressure drop throughout the system; this is typically about 5 mbar and thus amounts to about 20% of the target value of 25 mbar.
  • the extent of the pressure drop depends primarily on the air volume of the manometer, but also on the size of the tube and thus the volume of the cuff and its compliance.
  • the pressure drop makes a readjustment of the pressure in the cuff necessary after each pressure control.
  • the hand-held pressure gauge briefly generates an overpressure, and the air is subsequently vented until the desired pressure of, for example, 100.degree. 25 mbar is set. This measure often leads to coughing and / or gagging in patients. This is extremely uncomfortable for the patient and time-consuming for the nurses and thus also expensive.
  • the present invention therefore has for its object to provide a device with the features mentioned, which avoid the disadvantages of the prior art, in particular so for the patient is lenbar and less room for misinterpretation of the measured force leaves.
  • a valve is provided, which is designed such that it can be held in a closed state during the manufacture of the connection with the filling hose and after the production of the Connection with the filling hose and in particular can be opened after the subsequent construction of a pressure in the pressure build-up device.
  • the control of the cuff pressure is then carried out in such a way that first the connection of the pressure build-up and pressure measuring device is connected to the free end of the filling hose.
  • This free end usually has a so-called Luer connection with an integrated plug-in valve, ie a valve that automatically closes when releasing the free end of the filling hose from the terminal and can escape any gas from the filling hose to the outside, but by the Insertion of the connection of the pressure build-up and measuring device is opened.
  • an integrated plug-in valve ie a valve that automatically closes when releasing the free end of the filling hose from the terminal and can escape any gas from the filling hose to the outside, but by the Insertion of the connection of the pressure build-up and measuring device is opened.
  • the volume located between the free end of the connection and the valve arranged in the vicinity of this connection is connected to the filling hose and thus also to the cuff and an optional control balloon.
  • This volume is very small in comparison to the common volume of the cuff, the filling tube and the control balloon, so that the pressure in the cuff practically does not change or at best in the per thousand range by the production of this compound.
  • a pressure is built up to pressure control first in the pressure build-up device, which corresponds to the expected cuff pressure, so for example about 25 mbar. Only then the valve is opened at the terminal and thus establishes the connection between the pressure build-up device and the associated pressure gauge and the filling hose and the associated sleeve.
  • the difference then to be compensated between the pressure build-up device and the force cuff is of course much smaller, and in the relative volume ratios given above by way of example, ie if the volume of the pressure build-up device including pressure gauge is approximately 1/4 of the volume of the cuff together with the filling hose and the control balloon, In each case, the pressure in the cuff changes only about 1/4 of the actual difference between the cuff pressure and the pressure produced in the pressure building device. If no pressure change is detected on the manometer, this means that the pressure previously established in the pressure build-up device corresponds exactly to the cuff pressure. In the case of deviation from a desired set point, additional pressure is then built up in the pressure build-up device, gas is released until the desired pressure is reached. Then the valve is closed again and the connection can then be separated from the end of the filling hose, wherein the one-way valve closes again at the Luer connection of the filling hose.
  • valve is designed such that it opens at a predetermined target pressure in the interior of the pressure build-up device.
  • this pressure can be set to 25 mbar, so that when building up pressure in the pressure building device and after establishing the connection of the connection with the filling hose, the valve opens automatically, as soon as the target pressure is reached, then immediately with a pressure equalization the pressure prevailing in the cuff takes place. This can then be corrected if necessary.
  • the difference of the pressures in the pressure build-up device and in the cuff will usually be relatively low, it is particularly possible to equip the pressure build-up device with a larger volume, which then results in that at a larger pressure difference between the cuff and pressure build-up device after the preparation of the compound adjusting pressure is closer to the value previously set in the pressure build-up device.
  • the pressure-building device also has a device for measuring the volume flow of the gas forced out of the pressure-building device or possibly also flowing inward.
  • a device is a measuring cylinder with a corresponding piston and can in practice e.g.
  • a conventional syringe which is modified in that its volume has a connection to a pressure gauge and that in the tip of such a syringe valve according to the invention is arranged.
  • the pressures involved here typically differ from the normal atmospheric pressure of the environment only by 2 to 2.5, a maximum of 3%. Since approximately the ideal gas equation applies to ambient air or also to other gases which may be used to fill a cuff, a volume change in the pressure build-up device is sufficient by 2 to 3% in order to change the pressure by 20 to 30 mbar. Specifically, the volume is usually reduced by 2 to 3% in order to increase the pressure by 20 to 30 mbar.
  • the volume of the pressure build-up device (the volume of the measuring cylinder) is approximately equal to the total volume of the cuff, inflation tube and control balloon. If the pressure in the overall system then drops from 25 to 20 mbar after opening the valve, it can be seen that the pressure in the cuff may previously have been only 15 mbar if the volumes on both sides of the valve are approximately the same or equal . were. This can in turn be determined by reducing the volume in the pressure build-up device. Depending on how much the volume must be reduced in order to achieve the desired pressure of 25 mbar again, the volume beyond the valve is greater or smaller than the volume previously present in the pressure build-up device.
  • the volume of the measuring cylinder is 30 ml and after the connection has been established, the pressure has fallen from 25 to 20 mbar.
  • the previous assumption namely that the volume of the cuff, the filling tube and the control balloon was about the same size, so also was 30 ml, the pressure in the cuff would have previously been 15 mbar.
  • the volume of the pressure build-up device is reduced to increase the pressure back to 25 mbar, then the changes The total amount of gas in the system not, but there is instead a shift of gas from the measuring cylinder in the cuff instead.
  • the volume is correspondingly lower and it can be seen that possibly a wrong cannula or cuff size was used or for other reasons must be present, which prevent a proper inflation of the cuff.
  • excessive inflation of the cuff ie an unexpectedly large volume, may indicate that the cannula is too small or too small, which may not be sufficiently close to the trachea.
  • measuring device also has an additional inlet valve, for example in the piston, which makes it possible to set pressure and volume independently of each other.
  • the measuring cylinder could still have another connection for connection to an additional pressure building device.
  • a corresponding measuring cylinder is at least partially transparent, because then the movement of the piston is visible and volume changes of the cylinder volume are directly readable.
  • a blocking device is provided which is adjustable such that the piston is movable in one direction only, at least in certain operating conditions, namely in the direction of a further displacement of the gas volume in the measuring cylinder and not by the slight overpressure in turn pushed back inside the measuring cylinder.
  • This could be, for example, a simple ratchet mechanism which engages a fine toothing on a piston rod which serves to actuate the piston.
  • FIG. 1 shows a tracheostomy tube O with a pressure gauge 2 and a pressure build-up device
  • FIG. 1 a shows a variant of the pressure build-up device slightly modified from FIG. 1;
  • FIG. 2 shows a device similar to FIG. 1, but having a valve between pressure gauge, filling hose and pressure build-up device, and
  • FIG. 1 a shows a variant of the pressure build-up device slightly modified from FIG. 1;
  • FIG. 2 shows a device similar to FIG. 1, but having a valve between pressure gauge, filling hose and pressure build-up device, and
  • FIG. 1 a shows a variant of the pressure build-up device slightly modified from FIG. 1;
  • FIG. 2 shows a device similar to FIG. 1, but having a valve between pressure gauge, filling hose and pressure build-up device, and
  • FIG. 1 a shows a variant of the pressure build-up device slightly modified from FIG. 1;
  • FIG. 2 shows a device similar to FIG. 1, but having a valve between pressure gauge, filling hose and pressure build-up device, and
  • FIG. 1 a shows a variant of the pressure build-
  • FIG 3 shows an embodiment, similar to the embodiments of Figure 2, with an additional vent valve.
  • FIG. 1 shows a tracheostomy cannula designated as a whole by 10, which consists essentially of a cannula tube 11, a shield 12 movably attached thereto and a sleeve 1, which is also referred to as a cuff bladder.
  • the filling tube 13, which leads to the cuff 1, is either integrated into the wall of the cannula tube 1 1 or attached externally to this.
  • air (optionally also another gas) is pumped into the cuff 1, which is thereby inflated and is applied inside the trachea of a patient to the wall of the trachea and thereby seal the lung-side space of the trachea to the pharynx, to prevent or reduce the flow of secretion and the resulting risk of lung infections.
  • the tracheostomy tubes 10 in all embodiments have at the entrance of the control balloon 14, a check valve 18 which is opened by inserting a nozzle 17, thereby making a connection to the manometer.
  • a valve 7 closes the cross-section of the connecting piece 17 and thus allows a desired pressure before establishing the connection between filling hose 13 and control balloon 14 and the pressure gauge 2 and the pressure build-up device 20 in the pressure build-up device and the manometer , preferably the pressure expected in the cuff 1.
  • the valve 7 is opened and so on the filling hose 13, the control balloon 14 and the connecting piece 17, the connection between the sleeve 1 and the pressure gauge 2 and the pressure build-up device 20 produced.
  • the embodiment of Figure 1 a differs from the embodiment of Figure 1 only in that the rigid connection between the pressure gauge port 4 'is replaced with the connecting piece 17 by a flexible hose.
  • the pressure gauge port 4 ' as well as the terminal 4 in Figures 2 and 3, preferably designed so that a commercial syringe, as it is widely used in everyday medical use, with a conical Konnektorspitze (without injection needle) fits into a correspondingly formed connector opening can be used at the manometer connection 4 '.
  • the pressure gauge connection may optionally have a corresponding, possibly also exchangeable adapter for this purpose.
  • the syringe 3 or the syringe body can then be exchanged as desired and the user can select a syringe size that seems most suitable for the specific application. Such a syringe allows a much more sensitive setting of the cuff pressure than was possible with the usual balloon pumps.
  • the filling hose 13 is connected to a three-way cock 5 via a control balloon 14.
  • This three-way cock 5 is provided at a node of the connection of the filling hose 13 with a pressure gauge 2 and a pressure building device 20.
  • the pressure build-up device 20 consists essentially of a measuring cylinder 3 with a measuring scale 8 and a displaceably mounted therein piston 9, the ring via a piston 15 and a gripping ring 16 can be actuated.
  • the pressure build-up device essentially corresponds to a conventional syringe as is known and available in the medical field and may, for example, have a volume between 20 and 50 cm 3 .
  • the syringe has a luer connector 6, which is connected to a suitable nozzle 4, which emanates from the pressure gauge 2. At this nozzle 4 closes at the level of the valve 5 and the filling hose 13 at.
  • the valve 5 has three different positions. In a first position, only the measuring cylinder 3 and the pressure building device 20 is connected to the pressure gauge 2. In a further position, only the filling hose 13 is connected to the pressure gauge 2 and in a third position of the valve 5, the pressure building device 20, the pressure gauge 2 and the filling hose 13 are connected to each other. In addition, the three-way valve 5 is still a closed position in which the three systems connected, namely the pressure build-up device 3, the pressure gauge 2 and the filling hose 13 have no connection with each other.
  • the control balloon 14 serves to detect whether the filling hose 13 and the sleeve 1 connected to the filling hose are at all under a slight overpressure.
  • the inlet of the control balloon 14 connected to the valve stub 17 can also have a check valve, which is automatically opened by attaching the connection 18 of the control balloon to the connecting tube 17.
  • the pressure to be set in the cuff 1 is marked on the pressure gauge by a gray or colored area between approximately 15 and 30 mbar, the pressure gauge 2 indicating only the difference to the ambient pressure.
  • a vent valve 19 makes it possible to completely escape the overpressure present in the system.
  • the last set pressure in the cuff 1 has either been previously logged or has been set to a default value, for example 20 mbar. This is therefore the expected in the cuff 1 and the associated filling hose 13 and the control balloon 14 pressure.
  • the three-way valve 5 is then brought into a position in which initially only the pressure build-up device 3 and the pressure gauge 2 are connected to each other.
  • the piston 9 is displaced in the pressure build-up device 20 such that the pressure gauge indicates the expected in the cuff pressure of 20 mbar.
  • the valve is brought into a position in which only the filling hose 13 and the connection 17 for the filling hose 13 is connected to the pressure gauge 2.
  • the pressure gauge 2 will then display either a constant, a lower or even a higher pressure than 20 mbar. If, during the connection of the manometer 2 with the filling hose 13, the initially set pressure decreases from 20 mbar to 10 mbar, then it can be assumed that the cuff was practically in an unpressurized state, if the volume between the valve 5, over the Control balloon 14, the filling tube 15 and up to and including the sleeve 1 is about the same size as the volume of the manometer. If the volume of the manometer is comparatively smaller and the cuff 1 is depressurized, the pressure can also drop to levels well below 10 mbar.
  • connection with the pressure build-up device 20 can be restored, after which the pressure, starting from the situation described above, should rise again, since in the pressure building device previously a pressure of 20 mbar was set.
  • a mean pressure value is set, which is indicated by the pressure gauge 2 and from which one then in a relatively simple manner the entire volume of manometer, Can calculate control balloon, inflation hose and cuff.
  • the measuring scale 8 should be designed so that it covers the entire volume of the syringe, the Luer connection and the nozzle 4 to the valve 5, and when the compound of all three components is made, the pressure in the manometer increases from 10 mbar to 15 mbar, it is clear that the volume in control balloon, filling hose, cuff and manometer, including the respective connecting pieces, is also about 30 ml.
  • the pressure change is lower, ie, the pressure drops, for example, only to about 13 mbar, the volume of cuff 1, filling tube 13, control balloon 14 and pressure gauge must be correspondingly larger and then, for example, should be about twice the volume of the syringe.
  • the embodiment according to the invention avoids that the pressure in a cuff 1, which was set correctly, degrades too much when connecting to the pressure gauge 2 and indicates any smaller value which possibly leads to incorrect conclusions.
  • a pressure build-up device was permanently connected to the pressure gauge, so that the pressure was adjusted according to the relative volume ratio of cuff, filling hose and control balloon to the volume of pressure gauge and pressure build-up device, it could happen that
  • the pressure in the cuff was correctly about 20 mbar
  • the indicated pressure was clearly below 10 mbar, because the volume of the pressure build-up device and the manometer were possibly three to four times the volume of the cuff and adjacent tube sections. This could be erroneously interpreted as leakage or under-set pressure, which in turn sometimes led to excessive inflation of the cuff.
  • this is avoided solely in that the expected pressure can first be established in the pressure build-up device 20 and the manometer and only then the connection between the pressure gauge and the cuff takes place, the manometer compared to the cuff 1 and the sections connected to to the valve 5 has only a relatively small volume, so that after establishing the connection between manometer and filling hose via the valve 5, the pressure actually displayed is very close to the pressure previously present in the filling hose 13 cuff pressure.
  • FIG. 3 differs from the embodiment shown in Figure 2 only by a vent valve 19, with the help of which one may optionally also set too high a set pressure in the system.
  • valve positions an accurate determination of both the volume between valve 5 and cuff 1 (including the cuff), and also an accurate inference of the pressure prevailing in the cuff prior to connection to the manometer.
  • the pressure control is much more accurate when the pressure in the pressure gauge previously adjusted to the expected value and then the cuff is connected to the filling hose only with the Manometervolumen without simultaneously the volume of the pressure build-up device 20 is connected.
  • the system is easy to handle, and as the pressure build-up device 20, a conventional syringe of appropriate volume can be used.
  • the thus determinable volume of the cuff 1 provides an indication of the seat of the cuff in the trachea of a patient, so that one can see whether the cuff is even properly developed and probably rests against the wall of the trachea, if possibly too small or too large a cuff or tracheostomy tube 10 has been used and if there are any leaks in the system.
  • the entire device in the production and handling is relatively inexpensive and simple.

Abstract

L'invention concerne un dispositif de réglage et de commande de la pression dans des manchettes (1) de canules (10) endotrachéales ou de trachéostomie, qui présente un manomètre (2) et un dispositif (3) d'établissement de pression qui peut être relié au manomètre, ainsi qu'un raccordement (4, 4') qui assure la liaison du dispositif d'établissement de pression avec un tuyau flexible de remplissage (13) prévu dans la manchette. Pour obtenir un dispositif qui présente les caractéristiques indiquées ci-dessus mais qui évite les désavantages de l'état de la technique, et en particulier qui ménage le patient et donne peu d'espace à une interprétation erronée de la pression mesurée, il est prévu selon l'invention de disposer sur le raccordement du dispositif d'établissement de pression ou à proximité de ce dernier une soupape (5) configurée de manière à pouvoir être maintenue à l'état fermé pendant l'établissement de la liaison du raccordement au tuyau flexible de remplissage et à pouvoir être ouverte après l'établissement de la liaison avec le tuyau flexible de remplissage et en particulier après l'établissement ultérieur de pression dans le dispositif d'établissement de pression.
PCT/EP2007/050709 2006-01-25 2007-01-24 Dispositif de reglage et de commande de la pression dans des manchettes de canules endotracheales ou de tracheostomie WO2007085625A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
DE102006003442.2 2006-01-25
DE200610003442 DE102006003442A1 (de) 2006-01-25 2006-01-25 Vorrichtung zur Einstellung und Kontrolle des Druckes in Manschetten von Endotracheal- oder Tracheostomiekanülen

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Publication Number Publication Date
WO2007085625A1 true WO2007085625A1 (fr) 2007-08-02

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PCT/EP2007/050709 WO2007085625A1 (fr) 2006-01-25 2007-01-24 Dispositif de reglage et de commande de la pression dans des manchettes de canules endotracheales ou de tracheostomie

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DE (2) DE202006020162U1 (fr)
WO (1) WO2007085625A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2075024A1 (fr) * 2007-12-21 2009-07-01 Ulrich Frick Adaptateur de remplissage destiné à remplir un rembourrage
CN109999297A (zh) * 2018-11-16 2019-07-12 孙扬 一种可正压通气并可无创性插管的声门上装置

Families Citing this family (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
DE102013014450A1 (de) * 2013-08-30 2015-03-05 Oliver Müncheberg Lungen-Volumen-Vergrößerungs-Trainingsluftpumpe und auch Atemwege Erweiterungspumpe aus Materialien die keine allergenen Ausdunstungen haben
CN104667396A (zh) * 2013-11-29 2015-06-03 广州耀远实业有限公司 一种新型安全三通道喉罩

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US4178938A (en) * 1977-06-24 1979-12-18 Au Anthony S Pressure control systems
FR2561925A3 (fr) * 1984-03-30 1985-10-04 Novo Industri As Dispositif jetable pour injecter des quantites predeterminees et successives d'un medicament
GB2348607A (en) * 1999-04-08 2000-10-11 Mohamed Osman Abdelatti A cuff pressure controller for the laryngeal masks and tracheal tubes
US6579269B1 (en) * 1999-09-21 2003-06-17 Gennady I. Kleyman Dosage device
EP1525894A2 (fr) * 1997-12-24 2005-04-27 Anaesthesia Research Ltd. Surveillance et contrôle d'un masque endotrachéal

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US5460176A (en) * 1994-01-31 1995-10-24 Mallinckrodt Medical, Inc. Positive locking cannula
DE19514433C1 (de) * 1995-04-24 1996-01-04 Franz Prof Dr Med Waldeck Tracheostomiekanüle
DE10109935C2 (de) * 2000-03-10 2003-07-03 Primed Medizintechnik Gmbh Tracheostomaprothese
DE10359220A1 (de) * 2003-12-17 2005-07-28 Tracoe Medical Gmbh Tracheostomiekanüle
DE102005009577A1 (de) * 2005-02-28 2006-08-31 Tracoe Medical Gmbh Vorrichtung zur Atemluftzuführung

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Publication number Priority date Publication date Assignee Title
US4178938A (en) * 1977-06-24 1979-12-18 Au Anthony S Pressure control systems
FR2561925A3 (fr) * 1984-03-30 1985-10-04 Novo Industri As Dispositif jetable pour injecter des quantites predeterminees et successives d'un medicament
EP1525894A2 (fr) * 1997-12-24 2005-04-27 Anaesthesia Research Ltd. Surveillance et contrôle d'un masque endotrachéal
GB2348607A (en) * 1999-04-08 2000-10-11 Mohamed Osman Abdelatti A cuff pressure controller for the laryngeal masks and tracheal tubes
US6579269B1 (en) * 1999-09-21 2003-06-17 Gennady I. Kleyman Dosage device

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
EP2075024A1 (fr) * 2007-12-21 2009-07-01 Ulrich Frick Adaptateur de remplissage destiné à remplir un rembourrage
CN109999297A (zh) * 2018-11-16 2019-07-12 孙扬 一种可正压通气并可无创性插管的声门上装置

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DE102006003442A1 (de) 2007-07-26
DE202006020162U1 (de) 2007-11-22

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