Postural drainage (PD) is the drainage of
lungsecretions using
gravity.[1] It is used to treat a variety of conditions that cause the build-up of secretions in the lungs.
Uses
Postural drainage is used to treat any condition that causes the build-up of secretions in
bronchopulmonary segments. These include:
Patients must receive
physiotherapy to learn to tip themselves into a position in which the
lobe can be drained.
Contraindications
Postural drainage is often not suitable for
infants in the
neonatal intensive care unit, who may have lots of equipment attached to them.[5] Postural drainage is more difficult if patients experience poor
mobility,
poor posture,
pain,
anxiety, and
skin damage, usually requiring adaptations to the technique.[6] Trendelenburg position which is head down position is relatively contraindicated in patients who have uncontrolled hypertension,
orthopnea, recent gross
hemoptysis, patients having intracranial pressure more than 20 mm Hg.[7] Precautions should be taken with the patients who have rib fractures,
osteoporosis,
bronchospasm, and recent transplants.[8]
In postural drainage, the patient's body is positioned so that the
trachea is inclined downward and below the affected
chest area.[9] The body is positioned so that secretions drain into sequentially larger
bronchi.[5]Frames,
tilt tables, and
pillows may be used to support patients in these positions.[1][6] Up to 12 postures may be used.[10] Patients may need time to adapt to certain postures.[6]
Postural drainage is done at least three times daily for up to 60 minutes, with 30 minutes being common.[3] It can be done in the night to reduce coughing at night (although PD should be avoided after meals), or in the morning to clear
secretions accumulated during the night.
Bronchodilators can be used 15 minutes before PD is done to maximise its benefits.[11] The most affected area is drained first to prevent infected secretions spilling into healthy
lung. Drainage time varies, but each position requires 10 minutes.[12] If an entire
hemithorax is involved, each lobe has to be drained individually, but a maximum of three position per session is considered sufficient.
Use with other physiotherapies
Postural drainage is often used in conjunction with a technique for loosening secretions in the chest cavity such as chest
percussion.[13] Chest percussion is performed by clapping the back or chest with a cupped hand. Bronchodilator medications may also be used before postural drainage to improve its effectiveness.[6] Alternatively, a
mechanical vibrator may be used in some cases to facilitate loosening of secretions.[13][14] There are drainage positions for all segments of the lung. These positions can be modified depending on the patient's condition.
Postural drainage may be followed by
breathing exercises to help expel loosened secretions from the
airway, and coughing
exercises to expel secretions.
^
abDiBlasi, Robert; Gallagher, John T. (2017-01-01), Goldsmith, Jay P.; Karotkin, Edward H.; Keszler, Martin; Suresh, Gautham K. (eds.),
"27 - Respiratory Care of the Newborn", Assisted Ventilation of the Neonate (Sixth Edition), Elsevier, pp. 291–309.e4,
ISBN978-0-323-39006-4, retrieved 2020-11-17