The Science Journal of the American Association for Respiratory Care

Symposium Papers

July 2002 / Volume 47 / Number 7 / Page 769

Positioning Versus Postural Drainage

James B Fink MSc RRT FAARC

Introduction
Gravity
Posture and Turning
Postural Drainage
      Practice to Evidence
      Postural Drainage Procedure
External Manipulation of the Thorax
Contraindications for Postural Drainage
Hazards/Complications
Role of Exercise
Summary
For the past 70 years positioning and postural drainage have played an important role in increasing lung volumes, perfusion, oxygenation and mobilization of secretions. While gravity is not a primary mechanism for normal secretion clearance, it plays a major role in depth and pattern of ventilation, perfusion, and lymphatic drainage. Changing patient position, or turning patients on a regular basis, is a powerful tool in maintaining lung health in a broad range of patients. In contrast, postural drainage requires considerable investment of time, and has been shown to have limited benefit in most patients. Postural drainage has been shown to improve mobilization of secretions in patients with cystic fibrosis as well as patients who produce, and have difficulty clearing, large quantities of sputum. The benefits of postural drainage appear technique-dependent, requiring sufficient drainage time (3-15 min) for each position drained. The evidence does not support the use of vibration and percussion independent of active postural drainage. Exercise offers benefit in secretion clearance, which increases when combined with a program of postural drainage. In conclusion, routine turning, mobilization and exercise is important to maintain lung health in all patients, while postural drainage, properly applied, has been shown to improve secretion clearance in a relatively narrow range of patients with cystic fibrosis and excessive sputum production.
Key words: postural drainage, secretion clearance, chest physical therapy, cystic fibrosis.
[Respir Care 2002;47(7):769–777]

Introduction

Since the 1930s, clinicians have used gravity (by turning the patient) to increase lung volumes and oxygenation and to help mobilize secretions (via postural drainage). Low lung volume, ineffective cough, ventilation/perfusion mismatch, and thick secretions are commonly associated with pulmonary complications. Though postural drainage has become synonymous with secretion clearance in patients who have large volumes of secretions, there is a greater body of evidence supporting the therapeutic implications of mobilization and patient positioning for a broader patient population. This became evident to the team charged to develop the American Association for Respiratory Care's Clinical Practice Guideline on Postural Drainage. Consequently, that document expanded its scope beyond postural drainage, to include the therapeutic impact of positioning. In this paper I explore the practice of and the rationale and evidence for positioning and postural drainage in secretion clearance.

The entire text of this article is available in the printed version of the July 2002 RESPIRATORY CARE.

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