ROTOPRONE THERAPY SYSTEM. with people in mind.

ROTOPRONE THERAPY SYSTEM with people in mind www.arjohuntleigh.com

THE CLINICAL CHALLENGE: MINIMIZING MORTALITY AND POTENTIAL COMPLICATIONS IN ARDS PATIENTS WHILE MAKING IT EASIER TO DELIVER PRONE THERAPY MANAGING THE ARDS PATIENT: THE CHALLENGES OF DELIVERING PRONE THERAPY A SIGNIFICANT ISSUE Prone Therapy has been shown to help reduce mortality in ARDS patients by 25% when administered early and applied for most of the day.4 However, Prone Therapy isn t always administered due to the increased handling risks to both patients and caregivers, which can lead to additional facility costs. Acute respiratory distress syndrome (ARDS) is a serious and often fatal complication that can occur as a result of pneumonia, sepsis or trauma. Because it can severely compromise lung function and oxygenation, it is considered a medical emergency in the ICU. In 2008, the ARDS Foundation reported on the significant impact of this syndrome: 250,000 estimated ARDS cases in the U.S. in 20081,2 40% Risk to patients of tubing and line entanglement 4-6 caregivers required each time to manually prone a patient5 67% of disabling nursing injuries result from lifting patients6 of ARDS cases result in death3 CLINICAL CONSIDERATIONS: MANAGING THE COMPLICATIONS ASSOCIATED WITH ARDS When a patient develops ARDS, he or she is at risk for a wide range of pulmonary and respiratory complications, including: Ventilation and Perfusion Matching Gas exchange is optimal in alveoli where ventilation is closely matched to blood flow or perfusion. Clinical issue: If not enough blood flows through the lungs (poor perfusion) or not enough gas is exchanged (poor ventilation), V/Q mismatch may result in arterial hypoxemia. Ventilator-Induced Lung Injury Lung tissue damage as a result of mechanical ventilation. Clinical issue: Patients with ARDS require mechanical ventilation that can result in further injury to the lung and increase mortality by 9-33%.7 Pulmonary Secretions Pulmonary secretions can accumulate as a result of impairment of the mucociliary transport system, airway inflammation and constriction, or static supine positioning. Clinical issue: Excess or retained pulmonary secretions impair ventilation and gas exchange, promote infection and may threaten survival.

PRONE THERAPY: HELPING IMPROVE OUTCOMES IN ARDS PATIENTS THE MECHANISMS OF PRONE THERAPY Existing evidence suggests Prone Therapy functions through multiple mechanisms: Facilitates alveolar recruitment 8 Redistributes ventilation toward dorsal lung areas 9,10 Eliminates compression of the lungs by the heart 11 Facilitates drainage of pulmonary secretions 12 Reduces lung damage caused by mechanical ventilation 12 THE BENEFITS OF PRONE THERAPY Placing patients in the prone position offers a wide range of clinically demonstrated benefits when managing pulmonary complications. These include: Improved oxygenation 12,13 Improved ventilation and perfusion matching 14 Protection from ventilator-induced lung injury 12 Decreased mortality 4,15 PRONE THERAPY CLINICAL OUTCOMES Prone Therapy has been clinically proven in multiple studies to: Significantly reduce both overall and pulmonary-related mortality 15 Reduce ICU mortality by 25% when initiated early and applied often 4 Reduce hospital mortality by 19% 4 Significantly improve 10-day survival among high-risk patients 16 Reduce ventilation time by 17% 17 Reduce ICU length of stay by 26% 17 Reduce hospital length of stay THE CHALLENGES OF PRONE THERAPY Despite the clinical advantages of Prone Therapy, it is often underutilized by caregivers and institutions. There are many reasons why this occurs, including: Manual positioning is labor intensive 5,18,19 Risk management concerns for both patient and caregiver 20 Additional caregiver time and costs 19 Potential for tube and line entanglement or separation 5,18,19,20

THE SOLUTION: THE ROTOPRONE THERAPY SYSTEM AN EASY AND SAFE WAY TO DELIVER THE PROVEN BENEFITS OF PRONE THERAPY The RotoProne Therapy System is the only automated system that allows caregivers to deliver multiple intervals of Prone Therapy over an extended time. By automating this process, the RotoProne Therapy System can help manage patient handling risks associated with manual proning. 1 1 Helps Reduce Caregiver Risks The fully automated therapy system allows a single caregiver to prone a patient at the touch of a button. Helps Track Therapy Progress Digital therapy meters allow caregivers to easily track daily and cumulative therapy time. Helps Reduce Caregiver Time Touch screen controls allow caregivers to program multiple intervals of automated Prone Therapy.

2 2 Helps Prevent Tube Entanglement and Separation Integrated tube management system provides a more secure placement of patient tubing during rotation between supine and prone positions. 3 4 3 Enhances Patient Safety A hand control unit allows the caregiver to monitor lines and tubing during rotation to and from the prone position. 4 Provides Step-Down Therapy Delivers clinically proven Kinetic Therapy bilaterally rotating patients 40 or more for increased oxygenation and reduced risk of ICU-acquired pneumonia. 21

ROTOPRONE THERAPY SYSTEM PLACEMENT OPTIONS: THREE PROGRAMS DESIGNED TO MEET YOUR FACILITY S BUDGETARY NEEDS ROTOPRONE THERAPY BUSINESS MODELS THAT WORK FOR YOU To help facilities better manage resources and budgetary allocations, ArjoHuntleigh has created three separate programs for the RotoProne Therapy System: PURCHASE LEASE TO-OWN DAILY RENTAL ROTOPRONE PLACEMENT PROGRAM MATRIX Choose the program that best matches your RotoProne Therapy usage and budgetary resources. Placement Program Therapy Placements Capital Budget Purchase Frequent ( 25 per year) Available Lease-To-Own Frequent ( 3 per month) Not Available Daily Rental Infrequent ( 2 per month) Not Available ROTOPRONE THERAPY SYSTEM OWNERSHIP: PURCHASE OR LEASE-TO-OWN The RotoProne Therapy System is available for either Purchase or on a Lease-to-Own basis with flexible interest rates and terms that fit your budget. ROTOPRONE THERAPY SYSTEM RENTAL You may also Rent the RotoProne Therapy System on a daily basis depending on your facility s needs. ROTOPRONE FINANCIAL GUARANTEE No charge if patient does not show improvement within 96 hours.* When your patient is treated with the RotoProne Therapy System and no improvement is demonstrated within 96 hours, ArjoHuntleigh agrees to share the financial risk specifically related to the cost of the product rental by providing the bed placement for that patient at no charge.* RotoProne Therapy Systems are subject to availability. Sales, Lease-to-Own and Daily Rental Programs may not be available in a specific geographic area. Contact your local sales representative or call 1-800-343-0974 to determine whether these are available in your area. *RotoProne Financial Guarantee is subject to compliance with guidance and restrictions listed in ArjoHuntleigh s guarantee program and is subject to change at any time without notice.

THE COMMITMENT: IMPROVING PATIENT OUTCOMES YOUR PARTNER IN ARDS RISK MANAGEMENT As your partner in the management of ARDS, our goal is to help clinicians improve clinical outcomes while reducing associated patient and caregiver risks. Our clinical technologies, education programs and support services can help your facility better manage your nursing resources, reduce costs and improve outcomes among ARDS patients. CASE STUDY Prone Therapy initiated on hospital day 2. Patient discharged on hospital day 27 (18 days after discontinuation of Prone Therapy. Banner Desert Medical Hospital Mesa, Arizona Patient diagnosed with hypoxic respiratory failure was placed on the RotoProne Therapy System after standard therapies proved ineffective and condition worsened to ARDS. Within 24 hours, oxygenation improved and the patient stabilized. By hospital day 27, the patient was discharged and was capable of independent daily living activities. * Facility case study on file and available on request. Results may not be typical and may vary. 1. Verispan. 2007 ICD-9 Data. 2005 Data Year & 2006 ICD-9. 2004 Data Year (Unique Patients). 2. Growth rates calculated from Thompson Inpatient View CAGR % by group. 3. ARDS Foundation website. http://www.ardsil.com. 4. Mancebo et al. A MultiCenter Trial of Prolonged Prone Ventilation in Severe Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med, 2006; 173:1233-1239. This study utilized manual proning. 5. Ball, C. Use of the Prone Position in the Management of Acute Respiratory Distress Syndrome. Intensive and Critical Care Nursing, 2001; 15:192-203. 6. Premier, Preventing Back Injuries in Patient Care, available from http://premierinc.com. 7. CHEST, 2006 Symposia Highlights. 8. Buerin, C., Badet, M., Rosselli, S., et al. Effects of Prone Position on Alveolar Recruitment and Oxygenation in Acute Lung Injury. Intensive Care Med, 1999; 25:1222-1230. 9. Mutoh, T., Guest, R.J., Lamm, W., Albert, R.K. Prone Position Alters the Effect of Volume Overload on Regional Pleural Pressures and Improves Hypoxemia in Pigs in Vivo. Am. Rev. Respir. Dis. 1992; 146:330-306. 10. Richard, J.C., Janier, M., Lavenne, F., et al. Effect of Position, Nitric Oxide, and Almitrine on Lung Perfusion in a Porcine Model of Acute Lung Injury. Journal of Applied Physiology, 2002; 93:2181-2191. 11. Albert, R., Hubmayr, R. The Prone Position Eliminates Compression of the Lungs by the Heart. American Journal Respiratory Critical Care Medicine, 2000; 161:1660-1665. 12. Pelosi, P., Brazzi, L., Gattinoni, L. Prone Position in Acute Respiratory Distress Syndrome. European Respiratory Journal. Oct 2002; 20(4):1017-28. 13. Lee, D.L. Prone-Position Ventilation Induces Sustained Improvement in Oxygenation in Patients with Acute Respiratory Distress Syndrome Who Have a Large Shunt. Critical Care Medicine, July 2002; 30(7):1446-52. 14. Pappert, D., Rossaint, R., Slama, K., Gruning, T., Falke, K.J. Influence of Positioning on Ventilation-Perfusion Relationship in Severe Adult Respiratory Distress Syndrome. Chest, 1994; 106:1511-6. 15. Davis, J., et al. Prone Ventilation in Trauma or Surgical Patients with Acute Lung Injury and Adult Respiratory Distress Syndrome: Is it Beneficial? J Trauma, 2007; (62):1201 1206. This study utilized RotoProne Therapy System. 16. Gattinoni, L. Effect of Prone Positioning on the Survival of Patients with Acute Respiratory Failure. The New England Journal of Medicine, 2001; 345:568-573. 17. Watanabe, I., et al. Beneficial Effect of a Prone Position for Patients with Hypoxemia after Transthoracic Esophagectomy, Critical Care Medicine, 2002; 30(8):1799-1802. 18. Rowe, C. Development of Clinical Guidelines for Prone Positioning in Critically Ill Adults. Nursing in Critical Care, 2004; 9:50-57. 19. McCormick, J., Blackwood, B. Nursing the ARDS Patient in the Prone Position: the Experience of Qualified ICU Nurses. Intensive and Critical Care Nursing, 2001; 17:331-340. 20. Gosheron, M., Leaver, G., Forester, A., et al. Prone Lying a Nursing Perspective. Care of Critically Ill, 1998; 14:89-92. 21. Ahrens, T., Kollef, M., Stewart, J., Shannon, W. Effect of Kinetic Therapy on Pulmonary Complications. American Journal of Critical Care, 2004; Vol 13; No 5:376-382.

THE ONLY AUTOMATED SYSTEM DESIGNED TO DELIVER THE PROVEN BENEFITS OF PRONE THERAPY 01.TSS.0043.1.GB-INT.1.AHG May 2013 Only ArjoHuntleigh designed parts, which are designed specifically for the purpose, should be used on the equipment and products supplied by ArjoHuntleigh. As our policy is one of continuous development we reserve the right to modify designs and specifications without prior notice. and are trademarks belonging to the ArjoHuntleigh group of companies. ArjoHuntleigh, 2013. ArjoHuntleigh Inc. 4958 Stout Drive, San Antonio, Texas, USA P: 1-800-343-0974 www.arjohuntleigh.com