Postural drainage (PD) is the drainage of
lung 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 ...
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 m ...
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. ...
*
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 severi ...
*
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, patie ...
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 t ...
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 k ...
, who may have lots of equipment attached to them.
Postural drainage is more difficult if patients experience poor
mobility,
poor posture,
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
Turmoil may refer to:
* ''Turmoil'' (1984 video game), a 1984 video game released by Bug-Byte
* ''Turmoil'' (2016 video game), a 2016 indie oil tycoon video ...
, 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
Hemoptysis is the coughing up of blood or blood-stained mucus from the bronchi, larynx, trachea, or lungs. In other words, it is the airway bleeding. This can occur with lung cancer, infections such as tuberculosis, bronchitis, or pneumonia ...
, patients having intracranial pressure more than 20 mm Hg. Precautions should be taken with the patients who have rib fractures,
osteoporosis,
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 ...
, 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 resul ...
,
discomfort,
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 disc ...
. 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 cell ...
, 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 th ...
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.
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
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 stric ...
to clear
secretions 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 ...
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 l ...
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
lung. 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.
/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 ...
, and coughing exercises to expel secretions.
References
External links
MedlinePlus Encyclopedia
{{Respiratory system procedures
Respiratory system procedures