VPAPTM IV and VPAP IVTM ST Product Training VPAP is a trademark of ResMed Ltd and registered in U.S. Patent and Trademark Office. 1 VPAP IV/ST June 08 © ResMed

What treatment does it provide? Type of therapy CPAP and bilevel pressure support. * 4 – 20 cmH2O in CPAP mode ** 4 – 25 cmH2O in German VPAP IV 26013 Type of patients Respiratory Insufficiency and Obstructive Sleep Apnea Patients in the hospital and home Product Therapy mode Pressure VPAP IV CPAP, S 2 – 25 cmH2O* ** VPAP IV ST CPAP, S, ST, T 2 – 25 cmH2O* 2 VPAP IV/ST June 08 © ResMed

VPAP IV and VPAP IV ST Trusted VPAP performance now in Easy-Breath Technology platform Half the size, light and compact Whisper-quiet performance Faster rise time, enhanced new Vsync ResScan data card, Reminders, Review menu 3 VPAP IV/ST June 08 © ResMed

Features Compact, powerful and comfortable Popular S8 design Powerful: More than 140 L/min flow at 25 cmH2O Easy-Breath Technology Whisper-quiet High performance motor ResScan data card New Vsync algorithm Safer with supplemental oxygen Fine tuning with TiControl and 5 levels of trigger and cycling sensitivities 4 VPAP IV/ST June 08 © ResMed

S8 design - half the size of VPAP III series From 2.3 kg to 1.3 kg Popular and compact S8 form – common look and feel Pressure range 2 – 25 cm H2O Better pneumatic performance (more flow, faster rise time) 5 VPAP IV/ST June 08 © ResMed

Compatible with leading ResMed masks Nasal Masks Mirage Micro™ Ultra Mirage™, Ultra Mirage™ II Mirage Activa™ Mirage Vista™ Nasal Pillows Mirage Swift™, Mirage Swift™ II Full Face Masks Mirage Liberty™ Mirage Quattro™ Ultra Mirage 6 VPAP IV/ST June 08 © ResMed

Using humidifiers The heated humidifier H4i™ attaches to the front of the VPAP device. VPAP automatically detects the H4i, and no menu changes are required. The H4i seamlessly integrates with the VPAP for superior humidity 30% more humidification (compared with H3i) Choices of cleanable water chambers (standard) and disposable (accessory) water chambers 7 VPAP IV/ST June 08 © ResMed

Adding oxygen Oxygen can be added at the ResMed oxygen connector port (26960) Validated up to 15 L/min O2 FiO2 will vary, depending on the pressures, patient breathing pattern, mask (exhaust vent flow) and the leak 8 VPAP IV/ST June 08 © ResMed

Safer supplemental oxygen Safer therapy with oxygen up to 15 L/min Proprietary design (patent pending) maximises oxygen flow to the patient and enhances safety by reducing the chance of oxygen flowing back to the device. VPAP IV and VPAP IV ST have improved sealing air path. Oxygen VPAP Sample from Chris Brunner 9 VPAP IV/ST June 08 © ResMed

AB filter and battery Antibacterial filters can be used Low impedance filters (e.g. less than 2 cmH2O at 60 L/min) are recommended Triggering and cycling may be affected due to the increased resistance in the air circuit The VPAP can be powered by a battery using an inverter or ResMed DC 24V converter (26932) DC 24V converter should not be connected to the VPAP when the it is connected to AC power supply. This may generate electrical interference If, by accident, AC and DC are connected simultaneously, VPAP runs from AC power and automatically switches to DC when AC power is lost 10 VPAP IV/ST June 08 © ResMed

VPAP keypad and LCD 11 VPAP IV/ST June 08 © ResMed

Delivering therapy Without Smart Start/Stop Connect the power cord (no power switch on the device) Fit the mask Press Start/Stop key With Smart Start/Stop* Turn the power on (No power switch on the device) Fit the mask Breathe into the mask to start Remove the mask to stop The Smart Start/Stop feature on the VPAP IV and VPAP IV ST works as on the ResMed S8 series products. Selecting Full face mask and Leak Alert on the menus automatically disables the Smart Start/Stop. This is to avoid a problem when Smart Start does not work properly for a full face mask due to a loss of inhalation flow from the valve. It also avoids the confusion of having a part of the feature (Smart Start) staying on while the other (Smart Stop) gets disabled. NOTE Selecting Full Face Mask and Leak Alert automatically disables the Smart Start/Stop (see Notes) 12 VPAP IV/ST June 08 © ResMed

Ramp and H4i Warm-up Ramp or Settling time allows VPAP to slowly increase the pressure over the selected time When selected, Ramp or Settling appears after the Welcome screen Warm-up feature allows the water in the humidifier to warm up prior to starting treatment When the H4i is attached and the VPAP is powered, a display of warm up will appear 13 VPAP IV/ST June 08 © ResMed

Mask-fitting feature The mask-fitting feature helps the patient adjust the mask to effectively minimise leak While checking mask fit, VPAP delivers pressure similar to therapy pressure (IPAP) for three minutes Achieving 5 stars is extremely difficult, so don’t bother. The mask fit has a star rating up to five stars. Achieving a rating of three stars is effective. Note: VPAP copes well with leak so please DO NOT tighten the mask headgear straps. Hold down for 3 seconds 14 VPAP IV/ST June 08 © ResMed

VPAP S & ST benefits for patient Enhanced comfort, compliance and convenience: Compact and convenient S8 form Easy-Breathe Technology: Whisper-quiet motor Fast rise time and quick response Reminders (eg., to change mask, air filter) Better adherence with ResScan data card Comfort and effective humidification with H4i Selection of simplified and advanced Patient menu Synchronization with TiControl and 5 sensitivities 15 VPAP IV/ST June 08 © ResMed

VPAP S & ST benefits for clinicians Data Card for simple efficacy data & settings transfer Patient reminders (e.g. change mask) to ensure long term management Easy set-up by two layers of Clinical settings menus Treatment screens for real time therapy information SpO2 and HR on LCD by Reslink and oximeter High resolution Flow data on ResScan Adequate humidification by H4i Reliable Vsync technology Fine tuning by TiControl and 5 sensitivities 16 VPAP IV/ST June 08 © ResMed

Leak management - Vsync Essential for successful NPPV therapy Vsync monitors and compensates for leak by continuously and automatically adjusting the baseline flow therapy maintaining reliable triggering and cycling. 17 VPAP IV/ST June 08 © ResMed

Ti Control Inspiratory time control (S and ST mode) Ti Control provides minimum and maximum inspiratory time limits. The minimum and maximum time limits are set at either side of the patient’s ideal spontaneous inspiratory time, providing a ‘window of opportunity’ for the patient to spontaneously cycle to EPAP. Factory default: Ti Min 0.3 sec, Ti Max 2.0 sec. Patient can breathe out to EPAP spontaneously anytime between 0.3 and 2.0 second. When Ti Min and Ti Max are set at very close value, cycling to EPAP is almost like controlled, which becomes Respironics’ PC mode. 18 VPAP IV/ST June 08 © ResMed

Wide Trigger sensitivity Breath detection sensitivity to initiate IPAP is broadened from 3 to 5 levels. More fine tuning to suite individuals. 5 Trigger sensitivities Very High Quick to trigger 2.4L/min High Sensitive 4 L/min Med Default 6 L/min Low Less sensitive 10 L/min Very Low Slow to trigger 15 L/min Very High Very Low (Design specification) 19 VPAP IV/ST June 08 © ResMed

Wide Cycle sensitivity Breath detection sensitivity to cycle down to EPAP is broadened from 3 to 5 levels. More effective cycling for restrictive lungs. 5 Cycle sensitivities Very High Quick to cycle 50 % of peak flow High Sensitive 35% Med Default 25% Low Less sensitive 15% Very Low Slow to cycle 8% Very High Very Low (Design specification) 20 VPAP IV/ST June 08 © ResMed

Patient menu simplified Standard menu or Advanced menu Clinical Option menu has the menu type selection: Standard or Advanced. 21 VPAP IV/ST June 08 © ResMed

Clinical menu Settings and Advanced Settings Therapy Set-Up Fine-tuning Therapy 22 VPAP IV/ST June 08 © ResMed

ResScan Data Card Standard accessory for easy two-way data transfer The ResScan Data Card enables to gain remote access to the data stored in the VPAP device update therapy settings. The S8 Data Card stores: Device settings 180 Summary Sessions of patient’s data 2 Detailed Sessions of patient’s data 23 VPAP IV/ST June 08 © ResMed

Patient Reminder Recurring reminders allow the clinician to set reminders to alert the patient to specific event at set time intervals. Reminders are; Replace mask Replace filter Service Due Call provider Insert Card Customized message (up to 16 characters) In 7-day increments for a recurrence period of 1 - 24 months 24 VPAP IV/ST June 08 © ResMed

S8 ResLink Optional detailed monitoring VPAP on-board data storage: 5 detailed sessions 365 summary sessions Increase data storage and get SpO2 with S8 ResLink: 30 detailed sessions 365 summary session High resolution (25Hz) Flow data SpO2 and HR on VPAP LCD via ResLink and oximetry 25 VPAP IV/ST June 08 © ResMed

High res FLOW data 26 VPAP IV/ST June 08 © ResMed

More premium, professional look and feel New carry bag More premium, professional look and feel 27 VPAP IV/ST June 08 © ResMed