CA2617287A1 - Respiratory humidification system - Google Patents

Respiratory humidification system Download PDF

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Publication number
CA2617287A1
CA2617287A1 CA002617287A CA2617287A CA2617287A1 CA 2617287 A1 CA2617287 A1 CA 2617287A1 CA 002617287 A CA002617287 A CA 002617287A CA 2617287 A CA2617287 A CA 2617287A CA 2617287 A1 CA2617287 A1 CA 2617287A1
Authority
CA
Canada
Prior art keywords
sensor housing
flow
gases
flow rate
temperature
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.)
Granted
Application number
CA002617287A
Other languages
French (fr)
Other versions
CA2617287C (en
Inventor
Lewis George Gradon
Stephen William Mcphee
Paul John Seakins
Peter John Leonard
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.)
Fisher and Paykel Healthcare Ltd
Original Assignee
Fisher & Paykel Healthcare Limited
Lewis George Gradon
Stephen William Mcphee
Paul John Seakins
Peter John Leonard
Fisher & Paykel Limited
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 Fisher & Paykel Healthcare Limited, Lewis George Gradon, Stephen William Mcphee, Paul John Seakins, Peter John Leonard, Fisher & Paykel Limited filed Critical Fisher & Paykel Healthcare Limited
Publication of CA2617287A1 publication Critical patent/CA2617287A1/en
Application granted granted Critical
Publication of CA2617287C publication Critical patent/CA2617287C/en
Anticipated expiration legal-status Critical
Expired - Lifetime legal-status Critical Current

Links

Classifications

    • GPHYSICS
    • G01MEASURING; TESTING
    • G01FMEASURING VOLUME, VOLUME FLOW, MASS FLOW OR LIQUID LEVEL; METERING BY VOLUME
    • G01F1/00Measuring the volume flow or mass flow of fluid or fluent solid material wherein the fluid passes through a meter in a continuous flow
    • G01F1/68Measuring the volume flow or mass flow of fluid or fluent solid material wherein the fluid passes through a meter in a continuous flow by using thermal effects
    • G01F1/684Structural arrangements; Mounting of elements, e.g. in relation to fluid flow
    • G01F1/6842Structural arrangements; Mounting of elements, e.g. in relation to fluid flow with means for influencing the fluid flow
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/08Bellows; Connecting tubes ; Water traps; Patient circuits
    • A61M16/0816Joints or connectors
    • A61M16/0841Joints or connectors for sampling
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10Preparation of respiratory gases or vapours
    • A61M16/1075Preparation of respiratory gases or vapours by influencing the temperature
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10Preparation of respiratory gases or vapours
    • A61M16/1075Preparation of respiratory gases or vapours by influencing the temperature
    • A61M16/109Preparation of respiratory gases or vapours by influencing the temperature the humidifying liquid or the beneficial agent
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10Preparation of respiratory gases or vapours
    • A61M16/1075Preparation of respiratory gases or vapours by influencing the temperature
    • A61M16/1095Preparation of respiratory gases or vapours by influencing the temperature in the connecting tubes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10Preparation of respiratory gases or vapours
    • A61M16/14Preparation of respiratory gases or vapours by mixing different fluids, one of them being in a liquid phase
    • A61M16/16Devices to humidify the respiration air
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10Preparation of respiratory gases or vapours
    • A61M16/14Preparation of respiratory gases or vapours by mixing different fluids, one of them being in a liquid phase
    • A61M16/16Devices to humidify the respiration air
    • A61M16/161Devices to humidify the respiration air with means for measuring the humidity
    • GPHYSICS
    • G01MEASURING; TESTING
    • G01FMEASURING VOLUME, VOLUME FLOW, MASS FLOW OR LIQUID LEVEL; METERING BY VOLUME
    • G01F1/00Measuring the volume flow or mass flow of fluid or fluent solid material wherein the fluid passes through a meter in a continuous flow
    • G01F1/68Measuring the volume flow or mass flow of fluid or fluent solid material wherein the fluid passes through a meter in a continuous flow by using thermal effects
    • G01F1/684Structural arrangements; Mounting of elements, e.g. in relation to fluid flow
    • GPHYSICS
    • G01MEASURING; TESTING
    • G01FMEASURING VOLUME, VOLUME FLOW, MASS FLOW OR LIQUID LEVEL; METERING BY VOLUME
    • G01F1/00Measuring the volume flow or mass flow of fluid or fluent solid material wherein the fluid passes through a meter in a continuous flow
    • G01F1/68Measuring the volume flow or mass flow of fluid or fluent solid material wherein the fluid passes through a meter in a continuous flow by using thermal effects
    • G01F1/684Structural arrangements; Mounting of elements, e.g. in relation to fluid flow
    • G01F1/688Structural arrangements; Mounting of elements, e.g. in relation to fluid flow using a particular type of heating, cooling or sensing element
    • G01F1/6888Thermoelectric elements, e.g. thermocouples, thermopiles
    • GPHYSICS
    • G08SIGNALLING
    • G08BSIGNALLING OR CALLING SYSTEMS; ORDER TELEGRAPHS; ALARM SYSTEMS
    • G08B21/00Alarms responsive to a single specified undesired or abnormal condition and not otherwise provided for
    • G08B21/02Alarms for ensuring the safety of persons
    • G08B21/12Alarms for ensuring the safety of persons responsive to undesired emission of substances, e.g. pollution alarms
    • G08B21/16Combustible gas alarms
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0051Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes with alarm devices
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0057Pumps therefor
    • A61M16/0066Blowers or centrifugal pumps
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022Control means therefor
    • A61M16/024Control means therefor including calculation means, e.g. using a processor
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/10Preparation of respiratory gases or vapours
    • A61M16/14Preparation of respiratory gases or vapours by mixing different fluids, one of them being in a liquid phase
    • A61M16/16Devices to humidify the respiration air
    • A61M16/162Water-reservoir filling system, e.g. automatic
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/0003Accessories therefor, e.g. sensors, vibrators, negative pressure
    • A61M2016/003Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter
    • A61M2016/0033Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical
    • A61M2016/0039Accessories therefor, e.g. sensors, vibrators, negative pressure with a flowmeter electrical in the inspiratory circuit
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/18General characteristics of the apparatus with alarm
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/33Controlling, regulating or measuring
    • A61M2205/3331Pressure; Flow
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES 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
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/33Controlling, regulating or measuring
    • A61M2205/3368Temperature
    • YGENERAL TAGGING OF NEW TECHNOLOGICAL DEVELOPMENTS; GENERAL TAGGING OF CROSS-SECTIONAL TECHNOLOGIES SPANNING OVER SEVERAL SECTIONS OF THE IPC; TECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10TECHNICAL SUBJECTS COVERED BY FORMER USPC
    • Y10STECHNICAL SUBJECTS COVERED BY FORMER USPC CROSS-REFERENCE ART COLLECTIONS [XRACs] AND DIGESTS
    • Y10S261/00Gas and liquid contact apparatus
    • Y10S261/65Vaporizers

Abstract

A flow probe for use in a humidification system is disclosed. The flow probe is adapted to be positioned in a humidified gases flow (for example oxygen or anaesthetic gases) such as that which is provided to a patient in a hospital environment.
The flow probe is designed to provide both temperature and flow rate sensing of the gases flow by incorporating two sensors (preferably thermistors) and the shape and alignment of the probe enables accurate readings by reducing the occurrence of condensation on the sensors. A number of possible applications are disclosed wherein the flow sensor is included in humidification control systems which provide a patient with a desired humidity level or simplify the amount of user input required or wherein the flow sensor provides a controller with flow information which may then be used to determine certain, possibly dangerous, conditions (such as incorrect flow sensor placement, breathing circuit disconnected, no water in the humidification chamber or humidity out of required limits).

Claims (17)

1. Humidification apparatus for humidifying a gases flow to be supplied to a patient or other person in need of such gases comprising:

humidification chamber means adapted to hold a quantity of water and having an inlet and an outlet to allow said gases flow to pass through said humidification chamber means, heating means provided adjacent said humidification chamber means and adapted to provide heat to said quantity of water in said humidification chamber means in order to provide water vapour to said gases flow passing through said humidification chamber means, said heating means utilising a measurable quantity of power, gases transportation pathway means connected to said outlet of said humidification chamber means to convey said gases flow to said patient or other person in need of such gases, flow probe means adapted to sense the flow rate of said gases flow, control means which receives input from said flow probe means and storing a program which causes the control means to:

i) calculate the power usage required of said heating means in order to humidify said gases flow to a predetermined level at the gases flow rate sensed by said flow probe means, ii) determine the power presently being utilised by said heating means, and iii) supply said predetermined level of power to said heating means if the determined present power utilisation of said heating means is less than said required power usage.
2. Humidification apparatus as claimed in claim 1 wherein said step of calculating the power usage required of said heating means in order to humidify said gases flow comprises sensing the present gases flow by said flow probe means and searching in a data storage means for a previously stored power value associated with said sensed gases flow rate, said data storage means being previously supplied with flow rate and associated power usage values.
3. Humidification apparatus as claimed in claim 1 or claim 2 wherein said step of calculating the power usage required of said heating means in order to humidify said gases flow also comprises the steps of calculating the rate of evaporation required in order to attain said predetermined level at the sensed gases flow rate and then determining the power required of said heating means to produce the required said rate of evaporation.
4. Humidification apparatus as claimed in claim 1 or claim 2 wherein said humidification apparatus also comprises a temperature sensing means adapted to sense the temperature of said gases flow leaving said humidification chamber means and to supply a temperature signal to said control means and said program stored by said control means includes, between said steps (ii) and (iii), the step of:

iia) controlling the energisation of said heating means in order to maintain said gases flow rate exiting said humidification chamber means at a predetermined temperature.
5. Humidification apparatus as claimed in claim 1 or claim 2 wherein said program stored by said control means also comprise the subsequent step of:

iv) sensing the temperature of the gases leaving the humidification chamber means and returning to step (i) when the sensed temperature is less than said predetermined temperature.
6. Humidification apparatus as claimed in claim 1 or claim 2 wherein said flow probe means comprises:

sensor housing means adapted for positioning in said gases flow, said sensor housing means having a longitudinal axis substantially perpendicular to said humidified gases flow and a sensing end, sensing means housed within said sensor housing means at or near said sensing end, and at least one projecting tab means extending laterally from said sensor housing means, said at least one projecting tab means providing surfaces which enable liquid condensate to disperse away from said sensing end of said sensor housing means.
7. Humidification apparatus as claimed in claim 6 wherein said flow probe means comprise two said projecting tab means.
8. Humidification apparatus as claimed in claim 7 wherein said two projecting tab means are oppositely positioned around said sensor housing means.
9. Humidification apparatus as claimed in claim 6 or claim 7 wherein each said projecting tab means is aligned parallel to said gases flow.
10. Humidification apparatus as claimed in claim 6 or claim 7 wherein liquid condensate is dispersed along the lines of intersection between said sensor housing means and said projecting tab means, there existing a localised area of low surface tension along said lines of intersection.
11. Humidification apparatus as claimed in claim 6 or claim 7 wherein said flow probe means comprise a temperature sensor housing means and a flow rate sensor housing means.
12. Humidification apparatus as claimed in claim 11 wherein said sensing means of said temperature sensor housing means and said flow rate sensor housing means each comprise a temperature dependent resistance.
13. Humidification apparatus as claimed in claim 11 wherein said sensing means of said flow rate sensor housing means is occasionally heated to a predetermined difference temperature above the temperature of said gases flow, the power required by said sensor means of said flow rate sensor housing means to maintain said predetermined difference temperature providing an indication of the flow rate of said gases.
14. Humidification apparatus as claimed in claim 11 wherein said sensing means of said flow rate sensor housing means is exposed at or near the sensing end of the flow rate sensor housing means while the sensing means of said temperature sensor housing means is encapsulated at or near the sensing end of the temperature sensor housing means.
15. Humidification apparatus as claimed in claim 11 wherein said temperature sensor housing means and said flow rate sensor housing means are spaced across said gases flow in order that heat produced by the sensing means of said flow rate sensor housing means has substantially no effect on the sensing means of said temperature sensor housing means.
16. Humidification apparatus as claimed in claim 11 wherein said flow rate sensor housing means is positioned down stream of said temperature sensor housing means in order that heat produced by the sensing means of said flow rate sensor housing means does not effect the sensing means of said temperature sensor housing means.
17. Humidification apparatus as claimed in claim 6 wherein said gases transportation pathway means has a known cross-sectional area, at least in the region adjacent said sensor probe means, and is provided with a sensor entry port adapted to receive said flow probe means, said sensor entry port being provided with a fixed locating depression and said flow probe means being provided with a complimentary fixed locating tooth, the positioning of said temperature sensor housing means and said flow rate sensor housing means relative to said gases flow being controlled by the interconnection of said locating depression and tooth.
CA2617287A 1997-06-17 1998-06-16 Respiratory humidification system Expired - Lifetime CA2617287C (en)

Applications Claiming Priority (5)

Application Number Priority Date Filing Date Title
NZ328116 1997-06-17
NZ32811697 1997-06-17
NZ330295 1998-04-27
NZ33029598 1998-04-27
CA002447915A CA2447915C (en) 1997-06-17 1998-06-16 Respiratory humidification system

Related Parent Applications (1)

Application Number Title Priority Date Filing Date
CA002447915A Division CA2447915C (en) 1997-06-17 1998-06-16 Respiratory humidification system

Publications (2)

Publication Number Publication Date
CA2617287A1 true CA2617287A1 (en) 1998-12-17
CA2617287C CA2617287C (en) 2011-11-15

Family

ID=26651807

Family Applications (10)

Application Number Title Priority Date Filing Date
CA002240812A Expired - Lifetime CA2240812C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA002443306A Expired - Lifetime CA2443306C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2621885A Expired - Lifetime CA2621885C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2617287A Expired - Lifetime CA2617287C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2617553A Expired - Lifetime CA2617553C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA002447915A Expired - Lifetime CA2447915C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2621113A Expired - Lifetime CA2621113C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2617349A Expired - Lifetime CA2617349C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA002621638A Abandoned CA2621638A1 (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2619893A Expired - Lifetime CA2619893C (en) 1997-06-17 1998-06-16 Respiratory humidification system

Family Applications Before (3)

Application Number Title Priority Date Filing Date
CA002240812A Expired - Lifetime CA2240812C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA002443306A Expired - Lifetime CA2443306C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2621885A Expired - Lifetime CA2621885C (en) 1997-06-17 1998-06-16 Respiratory humidification system

Family Applications After (6)

Application Number Title Priority Date Filing Date
CA2617553A Expired - Lifetime CA2617553C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA002447915A Expired - Lifetime CA2447915C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2621113A Expired - Lifetime CA2621113C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2617349A Expired - Lifetime CA2617349C (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA002621638A Abandoned CA2621638A1 (en) 1997-06-17 1998-06-16 Respiratory humidification system
CA2619893A Expired - Lifetime CA2619893C (en) 1997-06-17 1998-06-16 Respiratory humidification system

Country Status (8)

Country Link
US (9) US6349722B1 (en)
EP (7) EP0885623B1 (en)
JP (7) JP3673402B2 (en)
CN (11) CN101306217B (en)
AU (2) AU729862C (en)
CA (10) CA2240812C (en)
DE (2) DE69822037T2 (en)
ES (2) ES2369850T3 (en)

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