Ge Healthcare Technologies Inc. · NASDAQ:GEHC

Ge Healthcare Technologies — Technical Presentation (April 2020)

26 slides from Ge Healthcare Technologies's technical presentation, Apr 7, 2020

1. Slide 1: COVID-19 pneumonia: Time course, monitoring and treatment

   COVID-19 pneumonia Time course, monitoring and treatment 2020 Luciano Gattinoni, MD, FRCP Georg-August-Universität Göttingen Germany

2. Slide 2: The main findings

   The main findings Covid‐19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome L. Gattinoni et al, AJRCCM 2020

3. Slide 3: Virus: epithelial-endothelial receptor

   VIRUS Epithelial – endothelial receptor Inflammation Interstial edema Where?

4. Slide 4: Inflammation + focused stress

   Inflammation + focused stress Peripheral densities

5. Slide 5: Time course of VILI development

   Time course of VILI development In 40 hours Lung Inhomogeneities and Time Course of Ventilator induced Mechanical Injuries Cressoni et al, Anesthesiology 2015

6. Slide 6: Lung vasoplegia

   Lung vasoplegia (undetermined mechanism) Nitric oxide Angiotensin I cGMP ACE2 Phosphorylated Angiotensin II myosin Vasodilation ?

7. Slide 7: Gravity dependent VA/Q mismatch

   Gravity dependent VA/Q mismatch VA/Q mismatch

8. Slide 8: Hypoxemia

   Undetermined Hypoxemia factors Increased respiratory drive VE – TV increase

9. Slide 9: Edema

   Edema crodamage Venous return Hypoperfusion

10. Slide 10: Positive pressure respiration and treatment of pulmonary edema

    Positive pressure respiration and its Acute Respiratory Failure Following application to the treatment of acute Pharmacologically Induced pulmonary edema Hyperventilation: An Experimental Animal L. Barach, Study Annals of Internal Medicine, 1938 D. Mascheroni et al, ICM, 1988 Mechanical Ventilation

11. Slide 11: When does the patient become dyspneic?

    When does the patient become dyspneic? 1600 Normal compliance 1400 1200 Received TV (ml) 1000 800 Decreased compliance 600 400 200 200 400 600 800 1000 1200 1400 1600 Expected TV (ml)

12. Slide 12: 7 days spontaneously breathing

    7 days spontaneously breathing O2 mask, CPAP, NIV COVID‐19 pneumonia: different respiratory treatment for different phenotypes? L. Gattinoni et al, ICM 2020 (in press)

13. Slide 13: Disease stage and possible interventions

    Disease stage Possible interventions Pre-infection Community medicine… Virus infection Antiviral drugs… Inflammatory reaction Corticoids, anti IL-6…

14. Slide 14: Disease stage and possible interventions

    Disease stage Possible interventions Vasoplegia NO, almitrine, CO2 … FiO2, CPAP, NIV, Prone Hypoxemia position… Respiratory drive Opioids, sedatives…

15. Slide 15: Progression of the disease: what can we do?

    Negative pressure Viral biology: Micro/macro thrombosis, Assess and control Anticoagulation ? Progression of the disease What can we do?

16. Slide 16: Negative intrathoracic pressure

    Negative intrathoracic pressure • Esophageal pressure • How to assess • Surface electromyography • Clinical signs • CPAP? • How to control • NIV? • Mechanical ventilation

17. Slide 17: Non invasive support: pro and con

    Non invasive support Pro Con • Increase PaCO2 • Increase oxygenation • May not decrease effort • May decrease the Ppl swings • Right ventricular failure • Acute Kidney Injury

18. Slide 18: How I set the ventilator

    How I set the ventilator • Mode • FiO2 Remember that it is • Tidal Volume a long lasting disease • Respiratory rate • PEEP

19. Slide 19: Which patient am I treating? Type L, Type H

    1. Which patient am I treating? Type L Type H

20. Slide 20: Which patient am I treating? Type L, Type H

    1. Which patient am I treating? Type L Type H • Low elastance • High elastance • Low VA/Q • High shunt • Low lung weight • High lung weight • Low recruitability • High recruitability

21. Slide 21: Mechanical ventilation Type L

    Mechanical ventilation Type L Sedation and muscle relax • Mode: Volume Controlled Ventilation Why? • FiO2: high as needed Why? • Tidal Volume: even > than 6 ml/kg Why? • Respiratory rate: try < 20 bpm Why? • PEEP: 8-10 cmH2O Why? • Prone position: only as a rescue Why?

22. Slide 22: Mechanical ventilation Type L

    Mechanical ventilation Type L Sedation and muscle relax In these high compliance patients (> 50 ml/cmH2O) the plateau, driving pressure and mechanical power levels are well below the “classical” severe ARDS

23. Slide 23: Mechanical ventilation Type H

    Mechanical ventilation Type H Sedation and muscle relax • Mode: Volume Controlled Ventilation Why? • FiO2: high as needed Why? • Tidal Volume: possibly 6 ml/kg Why? • Respiratory rate: to stay < 60 mmHg PaCO2 Why? • PEEP: possibly < 15 cmH2O Why? • Prone position: daily Why?

24. Slide 24: Mechanical ventilation Type H

    Mechanical ventilation Type H Sedation and muscle relax In these low compliance patients (< 50 ml/cmH2O) the plateau, driving pressure and mechanical power levels are the same of the “classical” severe ARDS

25. Slide 25: Weaning

    Weaning COVID-19 pneumonia lasts long, early weaning is problematic

26. Slide 26: Remember

    Remember 1. More than 50% do not have a “classical” ARDS 2. It’s a long course disease 3. 10 cmH2O of PEEP, sedation and especially patience is likely the best we can offer

Ge Healthcare Technologies — Technical Presentation (April 2020) on 6ix