Postural drainage

Postural drainage (PD) is drainage used in bronchiectasis and lung abscess. The patient's body is positioned so that the trachea is inclined downward and below the affected chest area.[1] Postural drainage is essential in treating bronchiectasis and patients must receive physiotherapy to learn to tip themselves into a position in which the lobe to be drained. It is done at least three times daily for up to 30 minutes. 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 accumulated secretions during the night. Bronchodilators can be used 15 minutes before PD is done to maximise its benefits.[2] The most affected area is drained first to prevent infected secretions spilling into healthy lung. Drainage time varies but each position requires 10 minutes.[3] If an entire hemithorax is involved, each lobe has to drained individual but a maximum of three position per session is considered sufficient. The procedure is discontinued if the patient complains of headache, discomfort, dizziness, palpitations, fatigue and dyspnea. Patients may be dyspnic after the various manuovers as the head-down position increases the work of breathing, reduces tidal volume and decreases FRC.

The treatment is often used in conjunction with a technique for loosening secretions in the chest cavity called chest percussion. Chest percussion is performed by clapping the back or chest with a cupped hand. Alternatively, a mechanical vibrator may be used in some cases to facilitate loosening of secretions.[4] 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.