Postural Drainage: A Guide

What is Postural Drainage?

Postural drainage is a therapeutic technique designed to help remove mucus from the lungs by positioning the body to use gravity to aid in drainage. It's commonly used in respiratory therapy for patients with conditions causing excessive mucus production, such as cystic fibrosis, bronchiectasis, pneumonia, and chronic obstructive pulmonary disease (COPD).

By placing the body in specific positions, different lung segments are positioned above the carina (where the trachea divides into the main bronchi), allowing mucus to drain from smaller airways into larger ones where it can be more easily expelled.

The Science Behind Postural Drainage

The human lungs consist of lobes containing smaller segments. In normal breathing, tiny hair-like structures called cilia move mucus toward larger airways. When mucus is excessive or cilia function is impaired, this natural cleaning mechanism becomes less effective.

Postural drainage uses gravity to compensate for impaired mucus clearance. This technique is often combined with percussion (chest clapping), vibration, and deep breathing exercises to further mobilize secretions.

Indications for Postural Drainage

Postural drainage is indicated for conditions characterized by excessive or retained secretions:

• Cystic fibrosis
• Bronchiectasis
• Atelectasis (lung collapse)
• Pneumonia
• Chronic bronchitis
• COPD
• Post-operative patients
• Patients with neuromuscular diseases

Positions for Postural Drainage

Each lung segment has an optimal position for drainage:

Combining Techniques

Percussion

Percussion involves rhythmic clapping with cupped hands over the chest wall to mechanically loosen secretions. This creates vibrations that help dislodge mucus.

Vibration

Vibration involves applying pressure with hands placed flat against the chest as the patient exhales, helping move mucus toward larger airways.

Coughing and Huffing

After drainage and percussion, patients are encouraged to cough or huff to expel loosened secretions. A "huff" is a forced exhalation through an open mouth.

Implementation Considerations

Timing

Postural drainage should ideally be performed on an empty stomach, waiting at least 1-2 hours after meals. Morning and bedtime treatments are often most beneficial.

Duration

Each position should typically be maintained for 5-10 minutes. The entire session usually lasts 20-45 minutes.

Frequency

The frequency depends on the individual's condition. Some patients may require treatment once or twice daily, while others may need 3-4 sessions per day.

Special Populations

Pediatric Patients

Infants and children require gentle technique and age-appropriate positioning. Making treatment enjoyable can help improve cooperation.

Elderly Patients

Older adults may have reduced mobility or osteoporosis requiring modified techniques and caregiver assistance.

Patients with Limited Mobility

Specialized equipment can help achieve positioning. Alternatives like high-frequency chest wall oscillation may be considered.

Tips for Successful Postural Drainage

• Stay hydrated to thin secretions
• Use prescribed bronchodilator medications before sessions
• Wear loose clothing
• Begin with less dependent positions and progress
• Take breaks if experiencing discomfort
• Report changes to healthcare providers

Conclusion

Postural drainage is a valuable technique for managing respiratory conditions characterized by excessive mucus production. When performed correctly and consistently, it can significantly improve lung function, reduce infection risk, and enhance quality of life.

Healthcare professionals should assess each patient individually to determine the most appropriate approach. As with any medical therapy, postural drainage should be conducted under the guidance of qualified healthcare providers.