Postural Drainage: Difference between revisions
No edit summary |
No edit summary |
||
| Line 10: | Line 10: | ||
== Introduction == | == Introduction == | ||
The term chest physiotherapy (CPT) stands for a spectrum of physical and mechanical interventions aimed at interacting therapeutically with acute and chronic respiratory disorders.<ref>Zach, M. S., & Oberwaldner, B. (2008). ''Chest Physiotherapy. Pediatric Respiratory Medicine, 241–251.'' doi:10.1016/b978-032304048-8.50022-0 </ref>Among various techniques for airway clearance, postural drainage is one of the widely used methods since decades. Postural drainage is the positioning of a patient with an involved lung segment such that gravity has a maximal effect of facilitating the drainage of | The term chest physiotherapy (CPT) stands for a spectrum of physical and mechanical interventions aimed at interacting therapeutically with acute and chronic respiratory disorders.<ref name=":0">Zach, M. S., & Oberwaldner, B. (2008). ''Chest Physiotherapy. Pediatric Respiratory Medicine, 241–251.'' doi:10.1016/b978-032304048-8.50022-0 </ref>Among various techniques for airway clearance, postural drainage is one of the widely used methods since decades. | ||
== Definition == | |||
Postural drainage is the positioning of a patient with an involved lung segment such that gravity has a maximal effect of facilitating the drainage of broncho-pulmonary secretions from the tracheobronchial tree.<ref>West MP. Postural Drainage. Acute Care Handbook for Physical Therapists. 2013 Sep 27:467.</ref>It is based on the concept of gravity-assisted mobilization of secretions and transport it for removal. It is a positioning technique to mobilize bronchial secretions. | |||
== Mechanism == | |||
During erect position only the segments of the right upper lobe and non-lingular portion of the left upper lobe receive gravitational assistance whereas the segment of the middle, lingular portion of left upper lobe and lower lobe segments of both lungs must drain against gravity. In normal healthy state, the mucociliary mechanism clears off the bronchial secretions. In diseased state they get compromised and secretions get accumulated especially in the smaller airways that cannot be emptied without gravity assistance which can further lead to inflammation and scarring.<ref name=":1">Balachandran A, Shivbalan S, Thangavelu S. Chest physiotherapy in pediatric practice. Indian pediatrics. 2005 Jun 1;42(6):559.</ref>The natural methods of emptying the tracheo-bronchial tree of accumulated secretion are on the whole extremely inefficient. Ciliary action -only removes minute particulate matter such as dust or bacteria, and is of no value when there is much secretion.<ref>Nelson HP. Postural drainage of the lungs. British medical journal. 1934 Aug 11;2(3840):251.</ref> | |||
== Procedure == | |||
The patient is tilted or propped at an angle required and chest percussion is performed to loosen the secretions. Frames, tilt tables, and pillows may be used to support patients in these positions.<ref name=":0" /> There are postural beds that have a hinge in the middle as well. | |||
In general, the upper lobe segments have the advantage of gravity drainage both in erect as well as in semi recumbent position, so postural drainage can be facilitated in sitting or lying posture. The middle and lower lobes do not have the advantage of gravity drainage in erect, semi-recumbent or recumbent postures. | |||
A footend elevation of 14-18 inches is requires for the drainage of middle and lower lobes.<ref name=":1" /> Each position consists of placing the target lung segment(s) superior to the carina. Positions should generally be held for 3 to 15 minutes (longer in special situations). Standard positions are modified as the patient's condition and tolerance warrant. | |||
In critical care patients, including those on mechanical ventilation, PDT should be performed from every 4 to every 6 hours as indicated. PDT order should be re-evaluated at least every 48 hours based on assessments from individual treatments. Domiciliary patients should be reevaluated every 3 months and with change of status.<ref name=":2">Sobush DC. The evolution of a clinical practice guideline: from chest physical therapy (CPT) to postural drainage therapy (PDT). Cardiopulmonary Physical Therapy Journal. 1992 Oct 1;3(3):4-7.</ref> . In the actively cooperating patient, postural drainage can be complemented by thoracic expansion exercises and by breathing control.<ref name=":0" /> | |||
== Indications == | |||
The following are the indications for postural drainage<ref name=":2" />:- | |||
* evidence or suggestion of difficulty with secretion clearance | |||
* difficulty clearing secretions with expectorated sputum production greater than 25-30 mL/day (adult) | |||
* evidence or suggestion of retained secretions in the presence of an artificial airway | |||
* presence of atelectasis caused by or suspected of being caused by mucus plugging | |||
* diagnosis of diseases such as cystic fibrosis, bronchiectasis or cavitating lung disease | |||
* presence of foreign body in airway | |||
== Contraindications == | |||
* often not suitable for infants in the NICU, who may have lots of equipment attached to them<ref>Goldsmith JP, Karotkin E, Suresh G, Keszler M. Assisted ventilation of the neonate E-book. Elsevier Health Sciences; 2016 Sep 2.</ref>. | |||
== Assessment for the need of postural drainage == | |||
The following should be assessed and reported to establish a need for postural drainage<ref name=":2" />:- | |||
* excessive sputum production | |||
* effectiveness of cough | |||
* history of pulmonary problems treated successfully with PDT (e.g., bronchiectasis, cystic fibrosis, lung abscess) | |||
* decreased breath sounds or crackles or rhonchi suggesting secretions in the airway | |||
* change in vital signs | |||
* Abnormal chest x-ray consistent with atelectasis, mucus plugging, or infiltrates | |||
* deterioration in arterial blood gas values or oxygen saturation | |||
Revision as of 10:09, 7 June 2021
Original Editor - Shreya Pavaskar
Top Contributors - Shreya Pavaskar, Naomi O'Reilly and Kirenga Bamurange Liliane
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (7/06/2021)
Introduction[edit | edit source]
The term chest physiotherapy (CPT) stands for a spectrum of physical and mechanical interventions aimed at interacting therapeutically with acute and chronic respiratory disorders.[1]Among various techniques for airway clearance, postural drainage is one of the widely used methods since decades.
Definition[edit | edit source]
Postural drainage is the positioning of a patient with an involved lung segment such that gravity has a maximal effect of facilitating the drainage of broncho-pulmonary secretions from the tracheobronchial tree.[2]It is based on the concept of gravity-assisted mobilization of secretions and transport it for removal. It is a positioning technique to mobilize bronchial secretions.
Mechanism[edit | edit source]
During erect position only the segments of the right upper lobe and non-lingular portion of the left upper lobe receive gravitational assistance whereas the segment of the middle, lingular portion of left upper lobe and lower lobe segments of both lungs must drain against gravity. In normal healthy state, the mucociliary mechanism clears off the bronchial secretions. In diseased state they get compromised and secretions get accumulated especially in the smaller airways that cannot be emptied without gravity assistance which can further lead to inflammation and scarring.[3]The natural methods of emptying the tracheo-bronchial tree of accumulated secretion are on the whole extremely inefficient. Ciliary action -only removes minute particulate matter such as dust or bacteria, and is of no value when there is much secretion.[4]
Procedure[edit | edit source]
The patient is tilted or propped at an angle required and chest percussion is performed to loosen the secretions. Frames, tilt tables, and pillows may be used to support patients in these positions.[1] There are postural beds that have a hinge in the middle as well.
In general, the upper lobe segments have the advantage of gravity drainage both in erect as well as in semi recumbent position, so postural drainage can be facilitated in sitting or lying posture. The middle and lower lobes do not have the advantage of gravity drainage in erect, semi-recumbent or recumbent postures.
A footend elevation of 14-18 inches is requires for the drainage of middle and lower lobes.[3] Each position consists of placing the target lung segment(s) superior to the carina. Positions should generally be held for 3 to 15 minutes (longer in special situations). Standard positions are modified as the patient's condition and tolerance warrant.
In critical care patients, including those on mechanical ventilation, PDT should be performed from every 4 to every 6 hours as indicated. PDT order should be re-evaluated at least every 48 hours based on assessments from individual treatments. Domiciliary patients should be reevaluated every 3 months and with change of status.[5] . In the actively cooperating patient, postural drainage can be complemented by thoracic expansion exercises and by breathing control.[1]
Indications[edit | edit source]
The following are the indications for postural drainage[5]:-
- evidence or suggestion of difficulty with secretion clearance
- difficulty clearing secretions with expectorated sputum production greater than 25-30 mL/day (adult)
- evidence or suggestion of retained secretions in the presence of an artificial airway
- presence of atelectasis caused by or suspected of being caused by mucus plugging
- diagnosis of diseases such as cystic fibrosis, bronchiectasis or cavitating lung disease
- presence of foreign body in airway
Contraindications[edit | edit source]
- often not suitable for infants in the NICU, who may have lots of equipment attached to them[6].
Assessment for the need of postural drainage[edit | edit source]
The following should be assessed and reported to establish a need for postural drainage[5]:-
- excessive sputum production
- effectiveness of cough
- history of pulmonary problems treated successfully with PDT (e.g., bronchiectasis, cystic fibrosis, lung abscess)
- decreased breath sounds or crackles or rhonchi suggesting secretions in the airway
- change in vital signs
- Abnormal chest x-ray consistent with atelectasis, mucus plugging, or infiltrates
- deterioration in arterial blood gas values or oxygen saturation
- ↑ 1.0 1.1 1.2 Zach, M. S., & Oberwaldner, B. (2008). Chest Physiotherapy. Pediatric Respiratory Medicine, 241–251. doi:10.1016/b978-032304048-8.50022-0
- ↑ West MP. Postural Drainage. Acute Care Handbook for Physical Therapists. 2013 Sep 27:467.
- ↑ 3.0 3.1 Balachandran A, Shivbalan S, Thangavelu S. Chest physiotherapy in pediatric practice. Indian pediatrics. 2005 Jun 1;42(6):559.
- ↑ Nelson HP. Postural drainage of the lungs. British medical journal. 1934 Aug 11;2(3840):251.
- ↑ 5.0 5.1 5.2 Sobush DC. The evolution of a clinical practice guideline: from chest physical therapy (CPT) to postural drainage therapy (PDT). Cardiopulmonary Physical Therapy Journal. 1992 Oct 1;3(3):4-7.
- ↑ Goldsmith JP, Karotkin E, Suresh G, Keszler M. Assisted ventilation of the neonate E-book. Elsevier Health Sciences; 2016 Sep 2.
