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Neonatal Value Proposition

The Benefits of Standardization Ways to decrease acquisition or training costs

June 11, 2012 2 |

Standardization: One vent for all sizes of patients

•  One vent for biomed •  One vent that can be moved anywhere in the hospital where patient

census is high

•  Fleet reduction for level 2 nurseries

•  One set of parts on the shelf •  One vent to train

Neonatal-Specific Changes Make the Puritan Bennett™ 840 Ventilator the Right Choice

• 2 ml tidal volume

• 300 gram minimum weight approval

• Leak compensation

• 20% increase FIO2

• CPAP mode

• IBW changes on the fly

• Flow sensor

• Neonatal-specific configuration

• Neonatal-specific trending

• Independent, proven trigger response time

• Cart with reduced footprint, enhanced battery capability

Covidien | June 11, 2012 | Confidential 3 |

© iStockphoto.com

Puritan Bennett™ 840 Ventilator Neonatal Modes of Ventilation

Covidien | June 11, 2012 |

• Assist Control (VC, VC+ and PC)

• SIMV (VC, VC+ - Dual Mode and PC)

• Bi-Level • Spontaneous • Volume Support –

Dual Mode • Pressure Support

• Assist Control (VC, PC) • SIMV (VC, PC) • Spontaneous (PS) • CPAP

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Breath Synchrony Strategies

Covidien | June 11, 2012 | Confidential 5 |

Modes

Bi-Level

Volume Support

Leak Compensation

Automatic sensitivity adjustments in NIV and invasive

Adjustable ESENS as needed

1 2

3

4 5

6

What is Important to You in the Performance of a Neonatal Ventilator

Covidien | June 11, 2012 |

C B

A D

Maintenance

Response Time

Synchrony - Automatic sensitivity adjustment

(Leak Compensation)

Ease of Use

Safety

Monitoring - Proximal flow sensor - Neonatal-specific

trending

- Rise time - Valve performance - ESENS

- Spontaneous inspiratory time

- Software and hardware (VC+)

6 |

© iStockphoto.com

Response Time

Covidien | June 11, 2012 | 7 |

PT = Pressure to trigger, TT = Time to trigger, TB = Time to return to baseline, T90 = Time to 90% of peak pressure, T-PTP = Trigger Pressure Time Product

Covidien | June 11, 2012 |

Marchese AD, Chipman DW, De La Oliva P, Kacmarek RM. Triggering and initial gas delivery. The Babylog vs. ICU ventilator in the NeoModes. Open Forum Abstracts. Resp Care. 2007.

Triggering and Initial Gas Delivery: The Babylog vs. ICU Ventilators in the NeoModes Andrew D. Marchese, Daniel W. Chipman, Pedro De La Oliva, Robert M. Kacmarek; Respiratory Care Services, Massachusetts General Hospital, Boston, MA

Ventilator Press to

Trigg. (ms)

Time to Trigg. (ms)

Time from Trigg. to Baseline

(ms)

Insp. T90 (ms)

Press. Time Product (cm H2O x ms)

Tidal Vol. (mL)

VIASYS/ CareFusion AVEA®*

-0.42 +- 1.04 -61.04 +- 2.18 12.11+-1.50 125.00+-21.28 11.86+-1.65 24.09+-4.74

Puritan Bennett™

840

-0.31 +- 0.03

-58.30 +- 2.56 8.11+-0.72 59.96+-8.19 5.99+-1.13 29.05+-4.02

SERVO-i ™* -0.59 +- 0.11

-65.14 +- 4.84 10.94+-1.72 41.60+-2.70 14.20+-4.11 28.17+-4.39

Dräger Babylog®*

-0.92 +- 0.14

-89.75 +- 3.32 12.99+-1.82 141.02+-24.31 33.57+-8.53 22.51+-4.92

Dräger Evita®* XL -0.84 +- 0.08 -91.41 +- 5.36 9.96+-1.08 46.58+-3.19 30.63+-8.25 29.13+-4.52

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C B

A D

Bird VIP Ventilator - Rise Time Test. Flow rate = 23L/min; ETT=2.5

05101520253035

0 1 2 3 4 5Time (sec)

Bird VIP Ventilator - Rise Time Test. Flow rate = 23L/min; ETT=4.0

05101520253035

0 1 2 3 4 5Time (sec)

840 Ventilator - Rise Time Test. Rise Time=100%; ETT=2.5

0

5

10

1520

25

30

35

0 1 2 3 4 5Time (sec)

840 Ventilator - Rise Time Test. Rise Time=100%; ETT=4.0

0

5

10

15

20

25

30

35

0 1 2 3 4 5Time (sec)

Rise Test V.I.P. Bird®* Ventilator and Puritan Bennett™ 840 Ventilator with High Flow (Fastest) with 2.5 and 4.0 ET Tube

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 9 |

V.I.P. Bird®* Ventilator – Rise Time Test. Flow rate = 23L/min; ETT=2.5

V.I.P. Bird®* Ventilator – Rise Time Test. Flow rate = 23L/min; ETT=4.0

PB840 Ventilator – Rise Time Test. Rise Time= 100%; ETT=2.5

PB840 Ventilator – Rise Time Test. Rise Time= 100%; ETT=4.0

Data from internal testing

The Active Exhalation Valve

Covidien | June 11, 2012 | 10 |

EXP

-20

A

B D

PS Termination Criteria (25%)

40 PCIRC cmH2O

INSP

L min

30 20 10 0 10 -2

0 20 15 10 5 0 5 10 15

V .

0 1 2 3s

Expiratory Sensitivity

• Pressure support breaths terminate when patient flow decelerates to a percentage of peak flow

• I-times too long or too short can also cause asynchronous breathing

Expiratory Sensitivity

• ESENS allows adjustment of the termination criteria for pressure supported breaths

– Sets the percent of peak flow that cycles the pressure support breath into exhalation

• Especially helpful to match the patient’s desired inspiratory time or to compensate for leaks

• NeoMode has increased the ESENS range to 80%

Increased ESENS setting to 40%

Flow

Leak Compensation

• Invasive and noninvasive

• Reduces auto-triggering

• Reduces delayed cycling

• Displays leak information

• Enhances Neo CPAP

• Max additional flow added –  15 lpm N, 20 lpm P, 40 lpm A

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 13 |

Noninvasive Neo CPAP Spontaneous breathing at set CPAP level

•  Implemented as a new mode •  Simplifies set up

•  Reduces nuisance alarms •  Allows apnea to be disabled

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 14 |

Neo FiO2 increase by 20%

• Single touch hard key

• Functions In NeoMode

• Useful prior to suction

• Improves safety

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 15 |

Change Ideal Body Weight While Ventilating New flexibility in a standard safety feature

• Does not change breathing settings

• No need to restart

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 16 |

Trending Software

Improves Data Management

• Customized and preset configurations

• Lung recruitment monitoring

• 72 hours of trended data

• Up to 53 monitored parameters

•  Help improve decision making

•  Help improve patient management

Covidien Respiratory and Monitoring Solutions | June 11, 2012 17 |

Events Not just ventilator-specific, but patient-specific

Manual Automatic

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 18 |

Covidien Respiratory & Monitoring Solutions | June 11, 2012 | Confidential 19 |

Puritan Bennett™ 840 Neonatal Ventilator Features Neonatal Trending Updates

Trending manual events available when circuit type is neonatal

- Surfactant Administration

- Prone position - Supine position - Left side position - Right side position - Manual stimulation

- VCV (Volume Control Ventilation) - PCV (Pressure Control Ventilation) -  BPD -  SURF - Weaning - N SIMV - N SPONT

Trending presets when circuit type is neonatal

New automatic events - FiO2 button

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Covidien Respiratory & Monitoring Solutions | June 11, 2012 | Confidential 20 |

Proximal Flow Sensor

• Will monitor only (does not control flow)

• Does not affect triggering/cycling

• Proximal flow data displayed –  Delivered tidal volume

–  Exhaled tidal volume

–  Exhaled minute volumes

• Trended values

• Screen will distinguish proximal flow sensor and other calculated values

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NOT FOR USE IN THE U.S.

Proximal Flow Sensor

Proximal Flow Sensor

Covidien Respiratory & Monitoring Solutions | June 11, 2012 | Confidential 21 |

• Low dead space (0.5 Ml)

• Low sensor weight

• Accuracy – Enhanced representation with what

is happening with the patient

• Purge – Tubes less prone to clogging prox flow sensor line

• Ventilator also has internal flow sensor to provide a reading if the prox flow sensor does not provide one.

• Proximal flow sensor technology – Differential pressure technology

• Calibration – Pre-calibrated

– Prox flow sensors are “hot-swappable”

• Range – Neonates up to 7kg

NOT FOR USE IN THE U.S.

Value of a Flow Sensor – Why at the Wye?

• Determine inspired TV in VC

• Determine inspired TV in PC

• Determine expired TV, remove impact of humidifier

• Determine leak amount

• Determine changes in compliance by a shift

• Identify over-distension on the PV-loop

Covidien Respiratory and Monitoring Solutions | June 11, 2012 22 |

NOT FOR USE IN THE U.S.

Volume Ventilation Plus Software

Full Support and Weaning

• Volume Control Plus (VC+)

A dual mode combining the best of VCV and PCV for mandatory breaths

• Volume Support (VS)

Ease of Use Features

• Coaching box

• Touch-sensitive settings

• Touch-sensitive parameters

• I:E ratio timing bar

• Help menu

• Visibility of all screens

• Color-directed instructions

• Vt/kg and MV feedback

Covidien | June 11, 2012 | 24 |

• More informative alarm messaging

• Occlusion algorithm

• Patient detection feature

• Disconnect sensitivity

• Infection control features

• Patient population locked

during SST

• Screen lock

• Soft bound limits

Standard of Safety

Neonatal-Specific Changes Making the Puritan Bennett™ 840 Ventilator the Right Choice

• 2 ml tidal volume

• 300 gram minimum weight approval

• Leak compensation

• 20% increase FIO2

• CPAP mode

• IBW changes on the fly

• Flow sensor

• Neonatal-specific configuration

• Neonatal-specific trending

• Independent, proven trigger response time1

• Cart with reduced footprint, enhanced battery capability

Covidien | June 11, 2012 26 |

1. Marchese Et al Triggering and initial Gas Deliver: The Baby - Log vs. ICU Ventilators in the Neo-Mode Respiratory Care Nov 2007

QUESTIONS

Covidien Respiratory and Monitoring Solutions | June 11, 2012 | Confidential 27 |