Understanding Postural Drainage
Postural drainage is a type of chest physiotherapy that uses different positions to encourage mucus and secretions to drain from the lungs' smaller airways into the larger ones, where they can be more easily coughed up. This therapy is commonly used for people with chronic lung diseases like cystic fibrosis, bronchiectasis, and COPD, as well as for temporary infections like pneumonia. The goal is to move congestion out of the lungs to make breathing easier and prevent further complications.
The Science Behind Gravitational Drainage
Gravity is the primary force leveraged in postural drainage. By positioning the body so that a particular lung segment is higher than the trachea (windpipe), gravity naturally assists the movement of secretions. This simple, non-invasive technique can be performed at home with the help of pillows or a bed that can be adjusted. It is important to perform these positions before meals or at least 90 minutes after eating to prevent vomiting.
Specific Positions for Different Lung Segments
Properly positioning the body is key to the effectiveness of postural drainage. The following are some of the most common positions used to target specific lung areas, though it is always best to consult a healthcare provider or physical therapist for a personalized plan.
Positions for Upper Lobe Segments
For mucus accumulation in the upper parts of the lungs, gravity-assisted drainage can be facilitated with seated or slightly reclined positions.
- Upper Front Segments: Sit upright in a chair or in bed, leaning back slightly against a pillow at a 30-degree angle. This position targets the upper anterior segments of the lungs.
- Upper Back Segments: Sit upright, leaning forward onto a pillow placed on your lap or a table in front of you. This helps drain the upper posterior segments.
Positions for Middle and Lower Lobe Segments
To drain the middle and lower lobes, it is necessary to place the body in positions where the hips are higher than the chest, which is often called the Trendelenburg position.
Draining the Lower Lungs
- Lower Back (Posterior Basal Segments): Lie face down (prone) with pillows under your hips, raising them about 18-20 inches higher than your chest. Drape your body over the pillows for support.
- Lower Front (Anterior Basal Segments): Lie on your back (supine) with pillows under your hips, elevating them 18-20 inches.
- Lower Side (Lateral Basal Segments): Lie on one side (e.g., left side to drain the right lung) with pillows under your hips, raising them 18-20 inches. Repeat on the opposite side to drain the other lung.
How to Perform Postural Drainage Safely
- Use pillows, cushions, or foam wedges to get as comfortable as possible and maintain the required angle.
- Wear comfortable, loose-fitting clothing.
- Hold each position for at least 5 minutes, or as instructed by your healthcare provider.
- After each position, sit up and perform controlled, or 'huff,' coughing to help expel the loosened mucus.
Combining Postural Drainage with Other Therapies
For maximum effectiveness, postural drainage is often combined with other airway clearance techniques (ACTs), particularly chest percussion and breathing exercises. This combination is known as chest physical therapy (CPT).
Chest Percussion and Vibration
- Percussion: A caregiver or therapist claps rhythmically on the chest wall over the affected lung segment with a cupped hand. This helps to loosen thick mucus. It should never be performed over bare skin or bony areas like the spine or breastbone.
- Vibration: Gently shaking the chest wall with a flattened hand or a mechanical vibrator as the patient exhales can help move secretions toward larger airways.
Breathing Exercises and Huff Coughing
Controlled breathing and coughing are essential components of the process. Huff coughing is a technique that uses short, forced exhales to move mucus up and out without causing airways to collapse.
A Step-by-Step Guide to Huff Coughing:
- Sit on the edge of a chair with your feet flat on the floor.
- Take a slow, deep breath in through your nose.
- Hold your breath for 3-5 seconds.
- Lean forward and exhale forcefully, as if you are trying to fog up a mirror. Repeat 2-3 times.
- Inhale slowly and gently through your nose to avoid taking a quick, deep breath that can trap mucus.
Comparing Postural Drainage Methods
| Method | Primary Principle | Required Equipment | Best For | Considerations |
|---|---|---|---|---|
| Standard Postural Drainage | Gravity-assisted positioning | Pillows, cushions, adjustable bed | Targeted drainage of specific lung lobes | May not be suitable for patients with certain conditions (e.g., hypertension, cerebral edema) |
| Chest Percussion/Clapping | Rhythmic clapping on chest wall | Cupped hands or mechanical device | Loosening thick, stubborn secretions | Requires a second person or a special vest; must avoid sensitive areas |
| Vibration | Gentle shaking of the chest wall | Hands or mechanical vibrator | Assisting movement of loosened mucus | Works best in conjunction with controlled breathing and positioning |
| Breathing Techniques | Diaphragmatic breathing, huffing | None | General airway clearance and maintenance | Can be performed independently and is easy to learn |
Conclusion: Tailoring Your Drainage Plan
Effective airway clearance is a personalized process. Knowing what is the position for drainage is the first step, but the best approach often combines multiple techniques. Before starting any new regimen, especially if you have an underlying health condition, it is vital to consult with a healthcare professional or respiratory therapist. They can determine the most appropriate positions and techniques for your specific needs, ensuring the procedure is both safe and effective. Remember to listen to your body and stop if you experience discomfort, pain, or dizziness. For more authoritative guidance, refer to resources like the National Institutes of Health (NIH).
