Postural drainage (PD) is the drainage of

lung The lungs are the primary organs of the respiratory system in humans and most other animals, including some snails and a small number of fish. In mammals and most other vertebrates, two lungs are located near the backbone on either side of t ...

secretion 440px Secretion is the movement of material from one point to another, such as a secreted chemical substance from a cell or gland. In contrast, excretion is the removal of certain substances or waste products from a cell or organism. The classical ...

s using gravity. 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: *

bronchiectasis Bronchiectasis is a disease in which there is permanent enlargement of parts of the bronchi, airways of the lung. Symptoms typically include a chronic cough with sputum, mucus production. Other symptoms include shortness of breath, hemoptysis, co ...

* lung abscesses *

cystic fibrosis Cystic fibrosis (CF) is a rare genetic disorder that affects mostly the lungs, but also the pancreas, liver, kidneys, and intestine. Long-term issues include difficulty breathing and coughing up mucus as a result of frequent lung infections. O ...

* atelectasis * chronic obstructive pulmonary disease (COPD) * pneumonia *

postoperative Surgery ''cheirourgikē'' (composed of χείρ, "hand", and ἔργον, "work"), via la, chirurgiae, meaning "hand work". is a medical specialty that uses operative manual and instrumental techniques on a person to investigate or treat a pat ...

lung damage (after some thoracic surgery) * Covid 19 Patients must receive

physiotherapy Physical therapy (PT), also known as physiotherapy, is one of the allied health professions. It is provided by physical therapists who promote, maintain, or restore health through physical examination, diagnosis, management, prognosis, patient ...

to learn to tip themselves into a position in which the lobe can be drained.

Contraindications

Postural drainage is often not suitable for

infant An infant or baby is the very young offspring of human beings. ''Infant'' (from the Latin word ''infans'', meaning 'unable to speak' or 'speechless') is a formal or specialised synonym for the common term ''baby''. The terms may also be used to ...

s in the

neonatal intensive care unit A neonatal intensive care unit (NICU), also known as an intensive care nursery (ICN), is an intensive care unit (ICU) specializing in the care of ill or premature newborn infants. Neonatal refers to the first 28 days of life. Neonatal care, as kn ...

, who may have lots of equipment attached to them. Postural drainage is more difficult if patients experience poor mobility,

poor posture Spinal posture is the position of the Vertebral column, spine in the human body. It is debated what the optimal spinal posture is, and whether poor spinal posture causes lower back pain. Neutral spine Looking directly at the front or back of the bo ...

pain Pain is a distressing feeling often caused by intense or damaging stimuli. The International Association for the Study of Pain defines pain as "an unpleasant sensory and emotional experience associated with, or resembling that associated with, ...

, anxiety, and skin damage, usually requiring adaptations to the technique. 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. Precautions should be taken with the patients who have rib fractures,

osteoporosis Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone ...

, bronchospasm, and recent transplants.

Risks

Postural drainage is considered safe and effective, but may cause some side effects. The procedure is discontinued if the patient complains of

headache Headache is the symptom of pain in the face, head, or neck. It can occur as a migraine, tension-type headache, or cluster headache. There is an increased risk of depression in those with severe headaches. Headaches can occur as a result ...

, discomfort, dizziness,

palpitations Palpitations are perceived abnormalities of the heartbeat characterized by awareness of cardiac muscle contractions in the chest, which is further characterized by the hard, fast and/or irregular beatings of the heart. Symptoms include a rapi ...

fatigue Fatigue describes a state of tiredness that does not resolve with rest or sleep. In general usage, fatigue is synonymous with extreme tiredness or exhaustion that normally follows prolonged physical or mental activity. When it does not resolve ...

, or dyspnea. Patients may be dyspneic after the various maneuvers, since the head-down position increases the work of

breathing Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen. All aerobic creatures need oxygen for cellular ...

, reduces tidal volume, and decreases functional residual capacity (FRC).

Technique

In postural drainage, the patient's body is positioned so that the trachea is inclined downward and below the affected chest area. The body is positioned so that secretions drain into sequentially larger bronchi.

Frames A frame is often a structural system that supports other components of a physical construction and/or steel frame that limits the construction's extent. Frame and FRAME may also refer to: Physical objects In building construction *Framing (co ...

, tilt tables, and pillows may be used to support patients in these positions. Up to 12 postures may be used. Patients may need time to adapt to certain postures. Postural drainage is done at least three times daily for up to 60 minutes, with 30 minutes being common. 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. The most affected area is drained first to prevent infected secretions spilling into healthy

. Drainage time varies, but each position requires 10 minutes. 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. Chest percussion is performed by clapping the back or chest with a cupped

hand A hand is a prehensile, multi-fingered appendage located at the end of the forearm or forelimb of primates such as humans, chimpanzees, monkeys, and lemurs. A few other vertebrates such as the koala (which has two opposable thumbs on each "h ...

. Bronchodilator medications may also be used before postural drainage to improve its effectiveness. Alternatively, a mechanical vibrator may be used in some cases to facilitate loosening of secretions.Bartolome R. Celli, MD (March 2013) Chest Physical Therapy. Merck & Co.
/ref> 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 Breathing (or ventilation) is the process of moving air into and from the lungs to facilitate gas exchange with the internal environment, mostly to flush out carbon dioxide and bring in oxygen. All aerobic creatures need oxygen for cellular ...

to help expel loosened secretions from the airway, and coughing exercises to expel secretions.

References

External links

MedlinePlus Encyclopedia
{{Respiratory system procedures Respiratory system procedures