What are the instructions for using bell vacuum (vacuum bell device) therapy to treat pectus excavatum?

Instructions for Using Vacuum Bell Therapy for Pectus Excavatum

The vacuum bell device should be used for a minimum of 30 minutes twice daily, with potential to increase up to several hours daily, and treatment should continue for 12-15 months for optimal results. 1

Patient Selection and Preparation

• Ideal candidates:

  • Children and adolescents (particularly those ≤11 years of age) 2
  • Patients with mild to moderate pectus excavatum
  • Patients seeking non-surgical correction options

• Before starting treatment:

  • Select appropriate vacuum bell size based on patient's age and chest dimensions
  • Ensure the skin of the chest is clean and dry
  • Apply a thin layer of skin protection (petroleum jelly) to create an airtight seal

Application Technique

1. Positioning:

   • Patient should be in a supine or semi-reclined position
   • Center the vacuum bell over the deepest part of the pectus excavatum

2. Creating vacuum:

   • Use the patient-activated hand pump to reduce pressure
   • Gradually increase negative pressure up to 15% below atmospheric pressure 1
   • The sternum elevation should be visible when proper vacuum is achieved

3. Duration and frequency:

   • Begin with 30 minutes twice daily 1
   • Gradually increase duration as tolerated
   • Optimal usage is >2 hours per day with daily application 3
   • Treatment course of 12-15 months is recommended 1

Monitoring Progress

• Follow-up evaluations should occur every 3 months 1, 4
• Documentation should include:
  • Photography of chest wall
  • Measurement of sternum elevation
  • Assessment of any side effects
  • Patient compliance with treatment regimen

Expected Results and Factors Affecting Outcomes

• Factors associated with better outcomes:

  • Starting treatment at age ≤11 years 2
  • Consistent use for >24 consecutive months 2
  • Daily application for >2 hours 3
  • Symmetrical (versus asymmetrical) pectus deformity 5

• Timeline for results:

  • After 3 months: 79% of patients show elevation >1.5 cm 1
  • After 12 months: Approximately 14.7% of patients achieve normal sternum position 1
  • Significant improvements in both depth and Haller Index with continued use 5

Potential Side Effects and Management

• Common side effects:

  • Skin erythema (15.3%) 2
  • Swollen skin (6.9%) 2
  • Chest pain (5.6%) 2
  • Chest tightness (1.4%) 2
  • Petechial bleeding or subcutaneous hematoma 5

• Management of side effects:

  • Temporary reduction in application time or pressure
  • Ensure proper positioning of device
  • Apply skin protection before use
  • If side effects persist, consult healthcare provider

Special Considerations

• The vacuum bell may also be used intraoperatively during minimally invasive repair procedures to facilitate safer passage of surgical instruments 1
• For asymmetrical deformities, special attention to positioning may be required
• Compliance is crucial for successful outcomes - emphasize the importance of consistent daily use

By following these instructions and maintaining consistent application, vacuum bell therapy offers a potential non-invasive alternative to surgical correction for selected patients with pectus excavatum.