1. TLR® Purpose: To provide protocol-driven respiratory care for the patient with atelectasis, ventilation/perfusion mismatch, and hypoxemia due to retained pulmonary secretions, with or without concomitant wheezing. IPV

2. TLR® Therapeutic HFPV devices IPV ® 2C IPV ® 1C Impulsator ® Impulsator ® HC The units provide the pneumatic flow and pressure required to operate the Phasitron®

3. TLR® Pulses of gas are delivered: Each has an inspiratory and expiratory phase (1:2.5 ratio) Gas is entrained during inspiratory phase (up to 1:5) – from nebulizer through entrainment port Open to ambient during expiratory phase – exhalation port Automatically clutches to adjust each pulse in response to the lung ® The Phasitron ® ; The patient interface

4. TLR® Pulses of gas are delivered to: Both preferential and obstructed airways Breach the secretion blockage Either through or around, depending on the type of secretion Once behind the blockage, alveoli are recruited and the secretion continues to be mobilized. So how does it work?

5. TLR® Phasitron ®

6. TLR® The Accessories Nebulizer, Connectors & O rings

7. TLR® The Complete Patient Interface AKA – Patient Circuit, Phasitron ® Includes – Phasitron ®, Nebulizer & hoses A50095-1

8. TLR® Phasitron ® - Specific for In-line

9. TLR® The Accessories Nebulizer (with float & drip port), Cone “wye”

10. TLR® The Complete Patient Interface AKA – Patient Circuit, Phasitron ® Includes – Phasitron ®, Nebulizer & hoses A50474-2

11. TLR® In-line set up

12. TLR® In-line results When in-line and when direct to airway? Patient stability, clinician comfort ®If a stable patient (such as quad or weaning patient) then much easier to use appropriate Phasitron ® direct to the airway ®If unstable and it is preferable to not break circuit or for continuous IPV ® then use Pressure Control (see vent videos following) and Cone in- line adapter.

13. TLR® IPV ® -1C Color coded connections For hose harness Percussion control Hard (100 bpm) to easy (300 bpm) adjust for comfort and effect Easy for more gas exchange and to loosen secretions, hard for more mobilization; scan through different rates later in the treatment Drive pressure control “Amplitude”; start at about 20 – slowly increase. Target 25 – 30 for peds, 35 – 40 for adults (may take several treatments to reach these pressures). Master on/off Proximal pressure monitor Manual Breath Try it on yourself before using on patient

14. TLR® IPV INDICATIONS With or Without the Cooperation of the patient. Ventilation&Oxygenation. Mobilization of of airways secretions. LungRecruitment