2008 Corporate Overview and Product Summary
Vapotherm Summary: Market leader and originator of High Flow Therapy Founded in 1999 Headquartered in Stevensville, MD Clinical and education leadership in High Flow Therapy Rapid adoption and sales growth in acute care (over 800 hospitals) Distributed in over 20 countries Private, venture-backed 2 Vapotherm provides patient-centered, non-invasive respiratory technologies that deliver superior outcomes, ease of use and costeffective care benefiting patients, clinicians and providers
Vapotherm High Flow Therapy Defined Combination of proprietary technology to achieve optimal temperature, humidity and flow rate at the point of delivery Flows of up to 40 liters per minute through the nares Supports efficiency of spontaneous respiration Provides non-invasive form of respiratory assistance for a broad range of conditions, improving patient compliance and comfort An alternative to more costly and complex therapies 3
Oxygen Therapy Nasal Cannula: Limited to flows of 1-6LPM Humidified at ATPS Fi02 variable (24-40%) Highest patient compliance of any device Low Flow / Variable Performance Mask Therapy: Unlimited flow rates True high flow limited to certain devices NRB mask not high-flow Uncomfortable and claustrophobic Therapy continually interrupted for meals, drug delivery, and communication High Flow Therapy: Adequate heat and humidity allow for high flows (1-40LPM) to be easily tolerated. Gas delivered at BTPS maintains normal airway function and improves mobilization of secretions. High flows improves utilization of the upper airway enabling a higher percentage of oxygen to be delivered. Higher Fi0 2 4
High Flow Nasal Cannula and Mask High nasal flow, unimpeded at mouth, fills the upper airways storing O 2 during exhalation (see Tiep, Malinoski) 100 90 80 70 60 50 40 30 20 10 0 N M 5
HFT Enhances Respiratory Efficiency Oxygenation Ventilation P i O 2 ~150 mmhg CONDITIONING PiCO2 ~0 mmhg CONDUCTION PAO2 ~100 mmhg PACO2 ~40 mmhg PATHOLOGY PaO2 ~95 mmhg PaCO2 ~40 mmhg 6
High Flow Therapy: Mechanisms of Action Flush Dead Space CO 2 Ventilation Oxygen Efficiency Support Inspiration Cannula Flow > inspiratory Work of Breathing Humidify / Warm Airways Nasal comfort Airway Reactivity 7
Clinical Validation Significant customer driven research with over 75 studies/abstracts in print including major peer-reviewed journals in respiratory, critical care and pediatrics. Conclusions include: HFT safe and effective for use in neonatal applications HFT better tolerated in infants than standard low flow cannula Improved exercise tolerance and reduction in dyspnea Improved oxygenation versus traditional mask therapy 8
High Flow Technology Foundation Patient Delivery Circuit Patented triple lumen design Design prevents rain-out Keeps gas conditioned out to patient No heated wire Vapor Transfer Cartridge: Key to efficient, high performance humidification and gas conditioning Massive surface area Humidification and Circuit Efficiency 9
Vapotherm 2000i First High Flow Humidification device on market Flows of 1-40LPM 95-100% relative humidity Temp range from 33-43C Over 5000 units sold Temperature and humidity control Gas blending via external mechanical blender and flowmeter Alarm functionality: Blocked tube Low water High temperature 10
Precision Flow Summary: Comprehensive High Flow Therapy Device Integrates flow control, gas blending, humidification and monitoring Comprehensive safety features Intuitive display, easy operation Robust engineering and components for minimal maintenance Self-calibrating controls and sensors 11 Precision Flow Integrates Heating, Humidification and Gas Blending in One Device
Indications for Use Precision Flow is intended for use to add warm moisture to breathing gases from an external source for administration to a neonate/infant, pediatric and adult patients in the hospital, subacute institutions, and home settings. It adds heat and moisture to a blended medical air/oxygen mixture and assures the integrity of the precise air/oxygen mixture via an integral oxygen analyzer. 12
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Disposable Patient Circuit 14 The Precision Flow Disposable Patient Circuit includes: Disposable water path (DWP) Water spike Patient delivery tube Vapor transfer cartridge (VTC) The VTC must be removed from package and attached to DWP The patient delivery tube must be attached by the user. It snaps into place in the bottom of the DWP The water spike is pre-attached to the DWP and requires no assembly other than spiking a sterile water source VTC Water spike Patient delivery tube attaches to bottom of Disposable water path
Excellence in High Flow Education: Regionally located certified respiratory therapists provide onsite clinical product support including in-servicing, technical support and continuing education Online Vapotherm Education Center (VEC) provides practical in-service courses as well as continuing education coursework Full compliment of job aids for device operation and best practices www.vtherm.com Knowledgebase: www.vtherm.com/support. Self-service knowledge center for biomeds and technical users of Vapotherm products 15 Vapotherm is committed to providing comprehensive educational support for clinicians, educators and patients