WO2018152606A1 - Sistema para monitoramento de parâmetros fisiológicos em circulação extracorpórea - Google Patents
Sistema para monitoramento de parâmetros fisiológicos em circulação extracorpórea Download PDFInfo
- Publication number
- WO2018152606A1 WO2018152606A1 PCT/BR2018/050030 BR2018050030W WO2018152606A1 WO 2018152606 A1 WO2018152606 A1 WO 2018152606A1 BR 2018050030 W BR2018050030 W BR 2018050030W WO 2018152606 A1 WO2018152606 A1 WO 2018152606A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- monitor
- transducer
- mini
- pressure
- ecc
- Prior art date
Links
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
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
- A61M1/3621—Extra-corporeal blood circuits
- A61M1/3639—Blood pressure control, pressure transducers specially adapted therefor
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/74—Details of notification to user or communication with user or patient ; user input means
- A61B5/742—Details of notification to user or communication with user or patient ; user input means using visual displays
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/02—Detecting, measuring or recording pulse, heart rate, blood pressure or blood flow; Combined pulse/heart-rate/blood pressure determination; Evaluating a cardiovascular condition not otherwise provided for, e.g. using combinations of techniques provided for in this group with electrocardiography or electroauscultation; Heart catheters for measuring blood pressure
- A61B5/0205—Simultaneously evaluating both cardiovascular conditions and different types of body conditions, e.g. heart and respiratory condition
-
- 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
- A61B5/6846—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive
- A61B5/6847—Arrangements of detecting, measuring or recording means, e.g. sensors, in relation to patient specially adapted to be brought in contact with an internal body part, i.e. invasive mounted on an invasive device
- A61B5/6866—Extracorporeal blood circuits, e.g. dialysis circuits
-
- 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
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
-
- 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
- A61M1/00—Suction or pumping devices for medical purposes; Devices for carrying-off, for treatment of, or for carrying-over, body-liquids; Drainage systems
- A61M1/36—Other treatment of blood in a by-pass of the natural circulatory system, e.g. temperature adaptation, irradiation ; Extra-corporeal blood circuits
- A61M1/3621—Extra-corporeal blood circuits
- A61M1/3666—Cardiac or cardiopulmonary bypass, e.g. heart-lung machines
-
- 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
- A61M2205/50—General characteristics of the apparatus with microprocessors or computers
- A61M2205/502—User interfaces, e.g. screens or keyboards
-
- 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
- A61M2230/50—Temperature
Definitions
- the present invention is an integrated system for monitoring physiological variables in cardiopulmonary bypass, which utilizes a pressure transducer specifically directed to act directly on the cardiopulmonary bypass.
- cardiopulmonary bypass also known as "CPB".
- CPB cardiopulmonary bypass
- the cardiopulmonary bypass circuit is quite complex and contains various devices, such as oxygenator, venous reservoir, arterial filter, etc., which provide, together with the pump, the necessary blood flow and oxygenation to maintain life. of the patient during surgery.
- Cardiopulmonary bypass is a high-risk procedure that requires careful monitoring of the patient's physiological parameters.
- a mechanical pressure transducer also known as a pressure isolator, which is a dome made up of two halves with a connector on each side and a flexible membrane that divides the two compartments.
- This type of transducer should be connected to the arterial line of the CPB circuit through a connector with a! Uer outlet and should be filled with fluid on the side that is connected to the arterial line. The other half should be left filled with air and connected to a mercury or aneroid pressure gauge.
- This type of transducer has a number of drawbacks.
- a first drawback relates to assembly difficulties, which require filling one side of the membrane with saline and positioning the membrane properly, otherwise the pressure measurement may be compromised.
- a second inconvenience relates to the fact that due to the high pressures, it is common for blood to enter the dome. may cause clotting and disrupt pressure reading.
- a third inconvenience is related to the damping of the pressure wave, that is, due to the nature of the device it is only possible to measure the average pressure in the circuit, which can lead to wrong conclusions, because in roller pumps, for example, It is common to have pressure spikes that are not identified by this type of system. Other drawbacks are still noted in this type of transducer.
- the disposable eelectronic pressure transducer is the second type known on the market and currently the most modern for patient pressure monitoring. It consists of a dome with a built-in eelectronic sensor with a cable with an electrical connector at one end that must be connected to an external pressure monitor.
- this transducer also has some drawbacks for pressure measurement during CPB, as it was not specifically designed to monitor the pressure in the cardiopulmonary bypass circuit.
- the electronic pressure transducer is supplied in a circuit that contains, in addition to the transducer itself, extensions, 3-way taps for zeroing the monitor, a serum device, and a continuous flow device.
- the transducer is connected to the circuit through a non-compliant extension, which in turn is connected to a luer lock output connector.
- the transducer circuit must be filled with saline so that pressure can be transmitted to the transducer.
- Another drawback concerns the continuous flow device provided with the transducer, which must be connected to a pressurized saline bag at 300 mmHg to avoid blood refluxing into the transducer line.
- the CPB circuit pressure to exceed 300 mmHg, when this happens there will be blood reflux in the line with consequent coagulation, making it difficult to monitor the pressure.
- the function of the flush device is to maintain a continuous flow of 3ml / h through the transducer circuit to prevent blood coagulation at the circuit end.
- the measuring points may be at different heights, account must be taken of the difference in height between the measuring point and the transducer attachment point when assessing the measured pressure, otherwise there may be an error in interpreting the measured values.
- thermo sensors are used which are mostly reusable type that cannot be placed directly in contact with blood in the CPB circuit.
- disposable adapters are generally used to thermally couple the reusable sensor to the blood at the measuring point.
- These adapters in addition to being difficult to access on the market, also introduce a measurement error due to the thermal coupling between the sensor and the adapter.
- temperature sensors are often of poor durability and may have read errors over their lifetime.
- the system according to the present invention thus comprises three basic components, namely, a CEC transducer, a coupled mini-monitor and an optional central monitor.
- Said ECC transducer can be produced in three versions, a pressure only transducer, a pressure and temperature transducer, or a temperature only transducer.
- FIG. 1 is a schematic view of the CPB pressure transducer according to the system object of the present invention.
- FIG. 2 is an electrical diagram of the CPB pressure transducer according to the system object of the present invention.
- Figure 3 is an electrical diagram of a second embodiment of the CPB pressure and temperature transducer according to the system or system object of the present invention.
- Figure 4 is an electrical diagram of a third embodiment of the CEC temperature transducer according to the system or system object of the present invention
- Figures 5A-5D are schematic left side, front side, right side and rear views, respectively, of the system mini-monitor object of the present invention
- Figure 6 is a schematic view of the compact central module of the system object of the present invention.
- Figure 7 is a schematic view of the alternate control module and video monitor assembly of the system object of the present invention.
- the minimal system for monitoring extracorporeal circulation physiological parameters comprises basically two components, an ECC transducer (10) coupled via a cable (20) to a mini-monitor (30) which is coupled to the CEC tube housing (90) which has a socket (100) for securing the assembly to a suitable bracket (not shown).
- FIG. 2 can be seen the wiring diagram of said CPB transducer (10), provided in various gauges to allow connection to the various tube gauges in the CPB circuits, with a disposable pressure sensor (51) embedded within the straight connector (1 1) and in direct contact (50) with the patient's blood. This way we can measure the pressure directly in the CPB circuit.
- the ECC transducer (10) may also include a disposable temperature sensor (52).
- the system for monitoring of physiological parameters in cardiopulmonary bypass according to the present invention further allows to achieve:
- both sensors are incorporated in the same housing, including one cable and one electrical connector,
- the ECC transducer 10 may have only the temperature sensor 52 for those procedures where only temperature measurement and control is required.
- the system for monitoring of physiological parameters in cardiopulmonary bypass provides a mini- pressure and temperature monitor (30) that is coupled directly to the CEC transducer (10), providing continuous readings of average circuit pressure and temperature without the need for any other accessories.
- Said mini-monitor (30) illustrated in Figures 5A-5D, has an analog circuit for amplifying and filtering the pressure and temperature signals from the disposable sensor and a CPU that digitizes and processes the analog signals for later display through the LCD display (1) on the equipment panel and digital transmission to an optional center monitor (not shown).
- this mini-monitor (30) is compatible with the three ECC transducer models (10) described above according to Figures 2, 3 and 4, respectively, pressure, temperature and pressure and temperature. Furthermore, said mini monitor 30 is also compatible with conventional pressure transducers. Furthermore, said mini-monitor (30) does not require any configuration. Simply connect the ECC transducer (10) or alternatively a conventional pressure transducer to the mini monitor (30) and it will display the values for available sensors, pressure, pressure and temperature or temperature only.
- mini-monitor (30) can be powered from an external source or a battery, or via digital communication cables when connected to the central monitor (not shown), dispensing with the external power supply.
- said mini-monitor (30) comprises a display (1) for displaying pressure and / or temperature values and a user interface, an electrical connector (2) for the ECC transducer (10) and optionally have an extension for better positioning.
- said mini-monitor (30) has a swivel fitting (3) for direct coupling to the CEC transducer (10) or circuit tube and an auxiliary damp fitting (4).
- the mini monitor (30) also has a connector (5) for external power supply and a connector (6) for the communication cable with the central monitor.
- the mini monitor (30) of the present invention has the following preferred technical characteristics: continuous monitoring of mean pressure with a range of -400 to +999 mmHg; continuous temperature monitoring with a range between - 20 and +50 Q C; bargraph for displaying instant pressure variations; visual and audible alarms for pressure and temperature; socket for direct coupling to the CEC transducer (10) or auxiliary clamp.
- said mini-monitor (30) has direct electrical coupling to the CEC transducer (10), without the need for intermediate cables, which improves signal / noise ratio and reduces signal interference, improving quality and reliability. signal coming from the transducer and hence the accuracy and reliability of pressure and temperature readings. It also includes automatic zero system as described in another patent by the same author, eliminating pressure transducer zeroing and allowing direct connection of the transducer to the CPB circuit, besides having extremely simple operation, simply by connecting the external power supply or installing the battery and turn on the mini monitor (30) and monitoring will start in a moment.
- the pressure and temperature mini-monitor (30) will likely meet the perfusionist's needs, but in some situations such as ECMO procedures, pump surgeries that provide pulsatile flow or surgeries. longer and more complex, additional information or resources may be required, such as pressure curves, systolic and diastolic pressure values, hydraulic resistance calculations, trend charts, alarms, etc.
- the mini-monitor (30) is provided with a connector for digital communication through which it sends data such as systolic, diastolic and mean pressure values and temperature to a central monitor (40), illustrated in Figure 8.
- This central monitor (40) is capable of to receive data from multiple mini-monitors (30, 30 ', 30 ", 30'” ⁇ and display them graphically and numerically in sync on one screen, and can perform various calculations such as the hydraulic resistance calculation which will be explained below, and also has other features common to vital sign monitors available in the market, such as visual and audible alarms, among others.
- said central monitor (40) when connected to the mini-monitor (30), besides receiving the data for display on the screen, provides it with the power needed for its operation, without the use of external sources or batteries.
- Said central monitor (40) may consist of a single compact unit with CPU, user interface and display, or may consist of a module containing the CPU and user interface control panel and an external video monitor video cable coupled for greater flexibility in operating room positioning and greater user convenience.
- said central monitor (40) is not restricted to pressure and temperature transducers, and can be used with other sensors such as flow and oximetry online or other equipment compatible with the communication protocol. of said central monitor (40).
- the compact central monitor (40) has a screen (41) and control buttons (42) for interaction with the software. It has connectors (43) and digital communication cables (44) for connection to the connectors (45) of the mini monitor (30).
- the system according to the present invention may comprise a control module (80) and video monitor (70) assembly, As shown in Figure 7.
- the central monitor (40) described in Figure 6 is replaced by an external video monitor unit (70), connected via video cable (80) to the control module ( 60), which has control buttons (not shown) for interaction with the remote monitor software (70).
- the mini monitor 30 has a CPU that digitizes and processes the signal, displaying it on the monitor's built-in display and sending the already properly processed pressure and temperature values as a digital signal to the monitor.
- the central monitor (40) does not it must have no analog circuitry, as it only displays the values previously processed by the mini-monitor (30).
- signals sent to remote monitor 70 via communication cables 80 are digital and therefore virtually immune to interference. The result of all this is a much simpler and less costly system than today's monitors, but with superior performance.
- the system is fully modular and can be scaled to meet user needs by simply adding new modules.
- the system may be tailored to the needs of each user or moment.
- the user may choose to use only the CPB transducer (10) and mini-monitor (30), or for more complex surgeries or procedures such as ECMO, may use multiple CPB transducers (10) coupled to respective mini-monitors (30) and a central monitor (40) for viewing and controlling all parameters, alarms and other features.
- the control module (60) + video monitor (70) system the control module (60) may be close to the perfusionist for greater ease of operation and ergonomics, and the video monitor (70) may be elevated to allow viewing by other healthcare professionals present in the operating room.
- the compact central monitor (40) which can be close to the center console, can be used for greater portability and ergonomics.
- the system is very easy to use. For complete monitoring, simply install the CEC transducers (10) into the cardiopulmonary bypass circuit, attach and connect the mini monitors (30) to the respective CEC transducers (10) and connect the mini monitors (30) to the center monitor. (40) via communication cables (44). When the equipment is turned on, the system automatically begins to monitor the circuit parameters without the need for any additional procedures. There is no need to even zero or level the transducers.
- the hydraulic resistance calculation can be very useful in situations where it is desired to evaluate the resistance variation of a cardiopulmonary bypass device throughout the procedure. For example, it is possible to verify the normal operation of an arterial filter or oxygenator by monitoring hydraulic resistance.
- To calculate the hydraulic resistance of a device two pressure transducers and one ultrasonic flow transducer are required, the transducers must be installed one before and one after the device to be evaluated and the flow sensor must be installed on the same line. next to the device.
- Rh (Pe - Ps) / flow
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Heart & Thoracic Surgery (AREA)
- Vascular Medicine (AREA)
- Cardiology (AREA)
- Biomedical Technology (AREA)
- Veterinary Medicine (AREA)
- Engineering & Computer Science (AREA)
- Animal Behavior & Ethology (AREA)
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- Physics & Mathematics (AREA)
- Pulmonology (AREA)
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- Measuring And Recording Apparatus For Diagnosis (AREA)
- Measuring Pulse, Heart Rate, Blood Pressure Or Blood Flow (AREA)
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Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US16/487,534 US11602584B2 (en) | 2017-02-22 | 2018-02-09 | System for monitoring physiological parameters in extracorporeal circulation |
BR112019017398-6A BR112019017398A2 (pt) | 2017-02-22 | 2018-02-09 | Sistema para monitoramento de parâmetros fisiológicos em circulação extracorpórea |
EP18756917.3A EP3586730A4 (en) | 2017-02-22 | 2018-02-09 | PHYSIOLOGICAL PARAMETERS MONITORING SYSTEM DURING EXTRACORPORAL CIRCULATION |
JP2019565593A JP7232198B2 (ja) | 2017-02-22 | 2018-02-09 | 人工心肺における生理学的パラメータをモニタリングするシステム |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
BRBR102017003716-9 | 2017-02-22 | ||
BR102017003716A BR102017003716A2 (pt) | 2017-02-22 | 2017-02-22 | sistema para monitoramento de parâmetros fisiológicos em circulação extracorpórea |
Publications (1)
Publication Number | Publication Date |
---|---|
WO2018152606A1 true WO2018152606A1 (pt) | 2018-08-30 |
Family
ID=63253484
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/BR2018/050030 WO2018152606A1 (pt) | 2017-02-22 | 2018-02-09 | Sistema para monitoramento de parâmetros fisiológicos em circulação extracorpórea |
Country Status (5)
Country | Link |
---|---|
US (1) | US11602584B2 (pt) |
EP (1) | EP3586730A4 (pt) |
JP (1) | JP7232198B2 (pt) |
BR (2) | BR102017003716A2 (pt) |
WO (1) | WO2018152606A1 (pt) |
Families Citing this family (1)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
EP4126365A4 (en) * | 2020-03-24 | 2024-04-03 | Merit Medical Systems Inc | BLOOD SENSOR ASSEMBLY |
Citations (2)
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US20040050168A1 (en) * | 2000-07-08 | 2004-03-18 | Andreas Uberreiter | System elements for measuring pressure in extracorporeal circuits |
US20080053255A1 (en) * | 2006-06-03 | 2008-03-06 | Pendotech | Universal sensor fitting for process applications |
Family Cites Families (13)
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JPS60102003U (ja) * | 1983-12-17 | 1985-07-11 | テルモ株式会社 | 体外血液循環回路用器具 |
JPH0523393A (ja) | 1991-07-18 | 1993-02-02 | Joji Oshima | 血圧測定装置 |
JP3375995B2 (ja) * | 1992-11-25 | 2003-02-10 | ミネソタ マイニング アンド マニュファクチャリング カンパニー | 医療用温度センサ |
US5993395A (en) | 1996-04-18 | 1999-11-30 | Sunscope International Inc. | Pressure transducer apparatus with disposable dome |
US6315751B1 (en) * | 1997-08-15 | 2001-11-13 | Cleveland Clinic Foundation | Cardiopulmonary bypass system using vacuum assisted venous drainage |
US8025199B2 (en) | 2004-02-23 | 2011-09-27 | Tyco Healthcare Group Lp | Surgical cutting and stapling device |
US20030135152A1 (en) | 2000-09-27 | 2003-07-17 | Kollar Kevin J. | Disposable cartridge for a blood perfusion system |
ITMI20050866A1 (it) | 2005-05-13 | 2006-11-14 | Marco Ranucci | Sistema di monitoraggio per interventi di chirurgia cardiaca con bypass cardiopolmonare |
JP2007105459A (ja) | 2005-10-12 | 2007-04-26 | Radi Medical Systems Ab | センサ・ワイヤ・アセンブリ |
DK1968703T3 (en) | 2005-12-28 | 2018-09-03 | Pt Stabilisation Ab | Method and system for compensating a self-caused tissue displacement |
GB2467133A (en) * | 2009-01-22 | 2010-07-28 | Papworth Hospital Nhs Foundati | Apparatus for providing short-term cardiac support |
JP6454071B2 (ja) | 2014-01-10 | 2019-01-16 | フクダ電子株式会社 | 患者監視装置 |
JP6277067B2 (ja) | 2014-06-03 | 2018-02-07 | 株式会社日立製作所 | 圧力センサ及びそれを備えた血圧測定システム、又は車載システム |
-
2017
- 2017-02-22 BR BR102017003716A patent/BR102017003716A2/pt not_active Application Discontinuation
-
2018
- 2018-02-09 BR BR112019017398-6A patent/BR112019017398A2/pt unknown
- 2018-02-09 JP JP2019565593A patent/JP7232198B2/ja active Active
- 2018-02-09 WO PCT/BR2018/050030 patent/WO2018152606A1/pt active Search and Examination
- 2018-02-09 US US16/487,534 patent/US11602584B2/en active Active
- 2018-02-09 EP EP18756917.3A patent/EP3586730A4/en active Pending
Patent Citations (2)
Publication number | Priority date | Publication date | Assignee | Title |
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US20040050168A1 (en) * | 2000-07-08 | 2004-03-18 | Andreas Uberreiter | System elements for measuring pressure in extracorporeal circuits |
US20080053255A1 (en) * | 2006-06-03 | 2008-03-06 | Pendotech | Universal sensor fitting for process applications |
Non-Patent Citations (3)
Title |
---|
"PendoTECH Single Use Pressure Sensors , versão PSSS-REV3", PENDOTECH, 21 February 2016 (2016-02-21), XP055535383, Retrieved from the Internet <URL:https://web.archive.org/web/20160807041027/http://www.pendotech.com/products/disposable_pressure_sensors/Pressure_Sensors_Spec_Sheet.pdf> [retrieved on 20180516] * |
"PendoTECH Single Use Temperature Sensors, version TSSS-REV11", PENDOTECH, 19 May 2016 (2016-05-19), XP055535390, Retrieved from the Internet <URL:https://web.archive.org/web/20170519015618if/http://www.pendotech.com:80/products/TemperatureSensorsMonitors/TemperatureSensors_SpecSheet.pdf> [retrieved on 20180516] * |
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Also Published As
Publication number | Publication date |
---|---|
EP3586730A4 (en) | 2020-08-26 |
BR112019017398A2 (pt) | 2020-03-31 |
EP3586730A1 (en) | 2020-01-01 |
US11602584B2 (en) | 2023-03-14 |
JP7232198B2 (ja) | 2023-03-02 |
US20200061278A1 (en) | 2020-02-27 |
BR102017003716A2 (pt) | 2018-10-30 |
JP2020508190A (ja) | 2020-03-19 |
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