Navi: Respiratory Services Postural Drainage

Postural Drainage

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POSTURAL DRAINAGE

Postural drainage therapy (PDT) is a component of bronchial hygiene therapy. It consists of postural drainage, positioning, and turning and is sometimes accompanied by chest percussion and/or vibration.

Postural drainage therapy is designed to improve the mobilization of bronchial secretions and the matching of ventilation and perfusion, and to normalize functional residual capacity (FRC) based on the effects of gravity and external manipulation of the thorax. This include :

1. Turning
2. Postural Drainage
3. External Manipulation of the Thorax

  • Percussion
  • Vibration

INDICATION
1. Turning

  • Inability to turn or change body position
  • Poor oxygenation
  • Potential for or presence of atelectasis
  • Presence of artificial airway
2. Postural drainage

  • Evidence or suggestion of difficulty with secretion clearance
    1. Difficulty clearing secretions
    2. Evidence or suggestion of re-tained 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


3. External Manipulation of the Thorax

CONTRAINDICATIONS

1.  Positioning

1.1. All positions are contraindicated for

  • Intracranial pressure more than 20 mmHg
  • Unstable head and neck injury
  • Active haemorrhage with hemodynamic instability
  • Acute spinal injury
  • Active haemoptysis
  • Empyema
  • Bronchopleural fistula
  • Pulmonary oedema associated with congestive heart failure
  • Large pleural effusions
  • Pulmonary embolism
  • Aged, confused, or anxious patients who do not tolerate position changes
  • Rib fracture, with or without flail chest
  • Surgical wound or healing tissue

1.2. Trandelenburg position is contraindicated for

  • Intracranial pressure more than 20 mmHg
  • Uncontrolled hypertension
  • Distended abdomen
  • Oesophageal surgery
  • Recent gross haemoptysis related to recent lung carcinoma treated surgically or with radiation therapy
  • Uncontrolled airway at risk for aspiration (tube feeding or recent meal)

1.3. Reverse Trandelenburg is contraindicated in the presence of hypotension or vasoactive medication

2. External Manipulation of the Thorax

In addition to contraindications previously listed

  • Subcutaneous emphysema
  • Recent epidural spinal infusion or spinal anaesthesia
  • Recent skin grafts, or flaps on the thorax
  • Burns, open wounds and skin infections of the thorax
  • Recent placed transvenous pacemaker or subcutaneous pacemaker
  • Suspected pulmonary tuberculosis
  • Lung contusion
  • Brochospasm
  • Osteomyelitis of the ribs
  • Osteoporosis
  • Complain of chest wall pain

Navi: Respiratory Services Postural Drainage