The vacuum method was used as early as 1910 by Lange. A vacuum bell is a plastic device that is connected to a pump. You place the bell-shaped device on the front of the chest and use a pump to suck the air out of the device. This creates a vacuum that pulls the chest forward. Over time, the chest wall stays forward on its own. Three different sizes of vacuum bells, as well as a model fitted for young women, exist. The appropriate size is selected according to the individual patient’s age and ventral surface. The device should be used at home for a minimum of 30 minutes (twice a day) and may be used up to a maximum of several hours daily. The intensity of the applied negative pressure can be evaluated with an integrated pressure gauge during follow-up visits. A prototype of an electronic model enables us to measure the correlation between the applied negative pressure and the elevation of the anterior chest wall.
In many cases of Pectus excavatum, the degree of pectus deformity does not immediately warrant surgery, yet patients may benefit from some type of nonsurgical treatment.
The lifting of the funnel involves a 3-part process affecting the bones, cartilages, and ligaments of the ribcage:
- an initial, reversible (elastic) deformation;
- a gradual, permanent transformation;
- and micro-ruptures, most likely occurring at the beginning of the treatment (until these ruptures heal, the patient?s ribcage will experience a slight temporary loss of firmness).
The funnel’s return to its concave position upon removal of the vacuum bell might be explained via the analogy of a competition between the ribcage’s firmness and the pull of muscles, including the diaphragm. Optimal responses to therapy appear to result from lifting the funnel slowly and continuously in such a way that the temporary losses of firmness in the ribcage are kept to a minimum. It should take some time (even 2 to 4 weeks) for the chest to be lifted to the degree that the funnel comes into contact with the viewing glass. The inward-pulling muscles, such as the diaphragm, become stretched by lifting the chest wall.
As a result of the complete duration of treatment, these muscles grow accustomed to their new position and to pulling the funnel less forcefully. In many cases, this growing process takes longer than any other part of the treatment.
How Do We Use the Vacuum Bell at Home?
There are few steps, which we will describe them detailed that you need to know in order to use properly the vacuum bell:
- Firstly you place the device on the chest. The center of it should be on top of the deepest part of your child’s pectus excavatum.
- Then push the device onto the chest to form a seal.
- Use the hand pump to suck the air out of the device. If your health care provider told you to pump to a certain pressure, follow those instructions. Otherwise, you should pump until you see your child’s chest wall rise.
- Remove the hand pump and plug the end of the tubing so your child can move around and the air does not leak out of the device.
- Leave the device on your child’s chest for the amount of time recommended by your healthcare
- Lift the device off of the chest when the time is up.
If your child is under 10 years old, you should help him or use the vacuum bell. Older kids can use the vacuum bell on their own.
To sum up, the use of a vacuum bell device is very simple indeed. The device is placed in the center of the patient’s chest above the sternum. It is then pushed onto the chest to pressurize the space contained underneath. The hand pump is then used to force air out of this space in order to create a partial vacuum. This process causes the sternum and chest wall to be sucked out, replacing the removed air, producing a more normal appearance to the chest. It is recommended that during the initial usage, the patient should increase the pressure to a comfortable level and leave the device on for roughly 30 minutes. After this period, the device can simply be lifted off the chest to release the pressure and remove the vacuum.
With subsequent uses, as the patient becomes more comfortable with the device, they will be able to extend the period of usage and increase the pressure within the contained space to a higher level. According to the experiences of our members, the vacuum bell should be used for a minimum of 30 minutes, twice per day, and may be used up to a maximum of several hours daily. More advice from members who have used the device can be found on the blog.
After removing the device, the sternum will gradually revert to its original position. However, with the continued usage of the device, the sternum will revert less each time, until a more normal position of the sternum is achieved. It is recommended that the vacuum bell is applied regularly on a daily basis throughout the period of treatment in order to maximize the effectiveness of the treatment, though many patients decide to work up to this frequency. A typical treatment period spans between one to three years, depending on the success of the treatment, though many users experience positive effects within a few months.
A comprehensive medical study was recently conducted in order to determine the effectiveness of vacuum bell treatment. It revealed highly positive and significant results and has cemented the vacuum bell treatment as a viable and effective option.
How Long Do Kids Need to Wear the Vacuum Bell?
At the very beginning, the child would need to wear it for 30 minutes, twice a day. After 5 weeks, when the kid will get used to it, you may increase the amount of time that your child wears it. You are free to go up to 2 hours, twice a day. Most kids need to use the vacuum bell for a year or more. Follow the recommendations from your healthcare provider for how long and how often your child should wear the vacuum bell. This way your child can get the best results.
Are There Any Problems With Using a Vacuum Bell?
Usually, the vacuum bell doesn’t cause problems except for a little redness or bruising where it attaches to the chest. The redness goes away after a few hours. Some people in rear cases, someone can have back pain or a burning or prickly feeling in the arms while wearing the vacuum bell. If they experience this, they should take off the vacuum bell and try a lower pressure in a few hours. Call your health care provider if this continues with the lower pressure.
As we said, there are very few complications or side effects associated with the use of vacuum bell therapy. However, some patients have experienced subcutaneous hematoma, petechial bleeding, dorsalgia and transient paresthesia of the upper extremities during the application of the device, though none of which are considered serious. In addition, there are extremely rare cases where inappropriate usage has resulted in rib fractures.
Is the Vacuum Bell Painful?
It can take some time to get used to the vacuum bell. Some kids might feel a bit of discomfort when the device is put on, but most get used to it pretty quickly. What If My Child Won’t Wear It?
Most kids do well with the vacuum bell. But if your child struggles, try to be understanding. Work together to come up with solutions and incentives to get your child to wear the vacuum bell. They can wear the vacuum bell under a shirt or even while they sleep. Your care team is a resource — for you and your child. They are there to answer any questions and help you and your child get the best results from the vacuum bell.
What Types of Vacuum Bell Are There?
Today, there are several different manufacturers of vacuum bells, their products have different shapes and sizes.
In our opinion, the most optimal solutions are developed in Russia.
The bells are of high quality and very effective, the prices are very reasonable.
Both a small bell for children from 3 years old (the size of the bell is only 11 cm) and giant models, up to 25 cm in diameter, were developed
international delivery is available
It should be noted that the manufacturer also offers the manufacture of a unique bell, according to the doctor’s sketches, if this is necessary for the patient, due to the characteristics of the body structure.
When creating the vacuum, the elevation of the sternum is obvious and persists for a distinct period of time. Therefore, the vacuum cup may also be useful in reducing the risk of injury to the heart during the MIRPE procedure, where the riskiest step of the procedure is the advancement of the introducer between the heart and sternum. Since the manufacturer of the device has not yet a license to sterilize the vacuum bell, this additional use has to be considered as a clinical trial. In addition, the vacuum bell may be useful in a way of ‘pretreatment’ to surgery.
In conclusion, the vacuum bell may allow some patients with PE to avoid surgery. Especially patients with symmetric and mild PE may benefit from this procedure. However, the time of follow-up in our series is too short to confirm this with any certainty. Additionally, the intraoperative use of the vacuum bell during the MIRPE may facilitate the introduction of the pectus bar. This must be evaluated by further studies. In any case, the method seems to be a valuable adjunct therapy in the treatment of PE.