What is Postural Drainage in Chest Physiotherapy

Postural drainage (bronchial drainage) in Chest Physiotherapy, the technique used for airway clearance, is a means of mobilizing secretions in one or more lung segments to the central airways by placing the patient in various positions. gravity effect on various positions taken by the patient. 

When secretions are moved from the smaller to the larger airways, they are then cleared by coughing or endotracheal suctioning. Postural drainage therapy also includes the use of manual techniques, such as percussion, shaking, and vibration, coupled with voluntary coughing.
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Goals and Indications for Postural Drainage

• Prevent Accumulation of Secretions in Patients at Risk for Pulmonary Complications
•  Patients with pulmonary diseases that are associated with increased production or viscosity of mucus, such as chronic bronchitis and cystic fibrosis
•  Patients who are on prolonged bed rest
•  Patients who undergo general anesthesia and who may have painful incisions that restricted deep breathing and coughing postoperatively
•   the patient who is on a ventilator if he or she is able enough to tolerate the treatment.
• Patients with acute or chronic lung disease, such as pneumonia, atelectasis, acute lung infections, COPD
•  generally very weak or are elderly Patients.
•  Patients with artificial airways

Relative Contraindications to Postural Drainage

• Severe hemoptysis
• Untreated acute conditions
• Severe pulmonary edema
• fever
• Congestive heart failure
• Large pleural effusion
• Pulmonary embolism
• Pneumothorax
• Cardiovascular instability
• Cardiac arrhythmia
• Severe hypertension or hypotension
• Recent myocardial infarction
• Unstable angina
• Recent neurosurgery
• Head-down positioning may cause increased intracranial pressure; if postural drainage is required, modified positions can be used.

Manual Techniques Used with Postural Drainage Therapy

to facilitate airway clearance, the use of body positioning, deep breathing, and an effective cough in a variety of manual techniques are used in conjunction with postural drainage to maximize the effectiveness of the secretions in the mucociliary transport system or lungs alveoli.

Postural Drainage includes percussion, vibration, shaking, and rib springing. Findings from studies that have been implemented to evaluate the efficacy of these manual techniques as adjuncts to postural drainage are inconclusive.

Percussion

Percussion is used to augment mobilization of secretions by mechanically dislodging viscous or adherent mucus from the airways. Percussion is performed with cupped hands. over the lung segment which is going to be drained.

The therapist with cupped hands strike on the patient’s chest wall in an alternating, rhythmic and synchronize manner. The therapist should lose shoulders, elbows, and wrists and mobile during the Postural Drainage maneuver. Mechanical percussion is an alternative to manual percussion techniques. Percussion is continued for several minutes depending on the need of the patient to alter the position to cough. the painful or uncomfortable procedure should be avoided.

(A) Hand position for applying percussion. (B) The therapist alternately percusses over the lung segment being drained.

PRECAUTIONS: To prevent irritation to sensitive skin, have the patient wear a lightweight gown or shirt. Avoid percussion over chest 7 breast area in women and over boney areas.

Relative Contraindications to Percussion

Before using percussion in a postural drainage program, a therapist must weigh the potential benefits versus potential risks. In most instances, it is prudent to avoid the use of percussion.

1. Over fractures, spinal fusion, or osteoporotic bone
2. Over tumor area
3. If a patient has a pulmonary embolus
4. If the patient has a condition in which hemorrhage could easily occur, such as in the presence of a low platelet count, or if the patient is receiving anticoagulation therapy
5. If the patient has unstable angina
6. If the patient has chest wall pain, for example after thoracic surgery or trauma.

Vibration

Vibration is another manual technique used in postural Drainage, often is used in conjunction with percussion to help move secretions to larger airways.

Hand placement for vibration during postural drainage.

during the expiratory phase as the patient is deep-breathing therapist applies vibration. Vibration is applied by the therapist with placing both hands directly on the skin and over the chest wall (or one hand on top of the other)of the patient and gently compressing and rapidly vibrating the chest wall as the patient breathes out for adequate time depending on condition.

The pressure is applied in the same direction as the chest is moving.  the therapist isometrically contracts(tensing) the muscles of the upper extremities from shoulders to hands to achieve The vibrating.

Shaking

Shaking is a vigorous form of vibration applied during exhalation using an intermittent bouncing (springing)maneuver coupled with wide movements of the therapist’s hands. thumbs are locked together, the open hands are placed directly on the patient’s skin, and fingers are wrapped around the chest wall, The therapist simultaneously shakes and compresses the chest wall. The patient may be positioned on a postural drainage table that can be elevated at one end, a tilt table, a reinforced padded table with a lift, or a hospital bed. A small child can be positioned on a therapist’s or parent’s lap.