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 ...

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 classica ...

s using

gravity In physics, gravity () is a fundamental interaction which causes mutual attraction between all things with mass or energy. Gravity is, by far, the weakest of the four fundamental interactions, approximately 1038 times weaker than the str ...

. 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 segment A bronchopulmonary segment is a portion of lung supplied by a specific segmental bronchus and its vessels. These arteries branch from the pulmonary and bronchial arteries, and run together through the center of the segment. Veins and lymphatic vess ...

s. These include: *

bronchiectasis Bronchiectasis is a disease in which there is permanent enlargement of parts of the airways of the lung. Symptoms typically include a chronic cough with mucus production. Other symptoms include shortness of breath, coughing up blood, and chest ...

lung abscess Lung abscess is a type of liquefactive necrosis of the lung tissue and formation of cavities (more than 2 cm) containing necrotic debris or fluid caused by microbial infection. This pus-filled cavity is often caused by aspiration, which may ...

es *

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 Atelectasis is the collapse or closure of a lung resulting in reduced or absent gas exchange. It is usually unilateral, affecting part or all of one lung. It is a condition where the alveoli are deflated down to little or no volume, as distinct ...

chronic obstructive pulmonary disease Chronic obstructive pulmonary disease (COPD) is a type of progressive lung disease characterized by long-term respiratory symptoms and airflow limitation. The main symptoms include shortness of breath and a cough, which may or may not produce ...

(COPD) *

pneumonia Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severit ...

* postoperative 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, pat ...

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 ...

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 ...

, 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 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 body, the 33 verte ...

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 Anxiety is an emotion which is characterized by an unpleasant state of inner turmoil and includes feelings of dread over anticipated events. Anxiety is different than fear in that the former is defined as the anticipation of a future threat w ...

, 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 Orthopnea or orthopnoea is shortness of breath (dyspnea) that occurs when lying flat, causing the person to have to sleep propped up in bed or sitting in a chair. It is commonly seen as a late manifestation of heart failure, resulting from fluid ...

, 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 am ...

bronchospasm Bronchospasm or a bronchial spasm is a sudden constriction of the muscles in the walls of the bronchioles. It is caused by the release ( degranulation) of substances from mast cells or basophils under the influence of anaphylatoxins. It causes d ...

, and recent transplants.

Risks

Postural drainage is considered safe and effective, but may cause some

side effect In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...

s. 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 of ...

discomfort Comfort (or being comfortable'')'' is a sense of physical or psychological ease, often characterized as a lack of hardship. Persons who are lacking in comfort are uncomfortable, or experiencing discomfort. A degree of psychological comfort ...

dizziness Dizziness is an imprecise term that can refer to a sense of disorientation in space, vertigo, or lightheadedness. It can also refer to disequilibrium or a non-specific feeling, such as giddiness or foolishness. Dizziness is a common medical ...

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 Shortness of breath (SOB), also medically known as dyspnea (in AmE) or dyspnoea (in BrE), is an uncomfortable feeling of not being able to breathe well enough. The American Thoracic Society defines it as "a subjective experience of breathing di ...

. 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 cellula ...

, reduces tidal volume, and decreases

functional residual capacity Functional residual capacity (FRC) is the volume of air present in the lungs at the end of passive expiration. At FRC, the opposing elastic recoil forces of the lungs and chest wall are in equilibrium and there is no exertion by the diaphragm ...

(FRC).

Technique

In postural drainage, the patient's body is positioned so that the

trachea The trachea, also known as the windpipe, is a cartilaginous tube that connects the larynx to the bronchi of the lungs, allowing the passage of air, and so is present in almost all air-breathing animals with lungs. The trachea extends from the l ...

is inclined downward and below the affected

chest The thorax or chest is a part of the anatomy of humans, mammals, and other tetrapod animals located between the neck and the abdomen. In insects, crustaceans, and the extinct trilobites, the thorax is one of the three main divisions of the crea ...

area. The body is positioned so that secretions drain into sequentially larger

bronchi A bronchus is a passage or airway in the lower respiratory tract that conducts air into the lungs. The first or primary bronchi pronounced (BRAN-KAI) to branch from the trachea at the carina are the right main bronchus and the left main bronchus ...

. Frames, tilt tables, and

pillow A pillow is a support of the body at rest for comfort, therapy, or decoration. Pillows are used in different variations by many species, including humans. Some types of pillows include throw pillows, body pillows, decorative pillows, and man ...

s 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

cough A cough is a sudden expulsion of air through the large breathing passages that can help clear them of fluids, irritants, foreign particles and microbes. As a protective reflex, coughing can be repetitive with the cough reflex following three ph ...

ing at night (although PD should be avoided after meals), or in the

morning Morning is the period from sunrise to noon. There are no exact times for when morning begins (also true of evening and night) because it can vary according to one's lifestyle and the hours of daylight at each time of year. However, morning str ...

to clear secretions accumulated during the night.

Bronchodilator A bronchodilator or broncholytic (although the latter occasionally includes secretory inhibition as well) is a substance that dilates the bronchi and bronchioles, decreasing resistance in the respiratory airway and increasing airflow to the lung ...

s 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 A percussion instrument is a musical instrument that is sounded by being struck or scraped by a beater including attached or enclosed beaters or rattles struck, scraped or rubbed by hand or struck against another similar instrument. Exc ...

. 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 " ...

. 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 to help expel loosened secretions from the

airway The respiratory tract is the subdivision of the respiratory system involved with the process of respiration in mammals. The respiratory tract is lined with respiratory epithelium as respiratory mucosa. Air is breathed in through the nose to th ...

, and coughing

exercises Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...

to expel secretions.

References

External links

MedlinePlus Encyclopedia
{{Respiratory system procedures Respiratory system procedures