Postural drainage

The traditional form of chest physiotherapy (CPT) is known as percussion and postural drainage. Areas of the patient s chest, sides, and back are rapidly clapped by hand in different patient positions, followed by cough or forced expiration to... 

Postural drainage may assist in promoting clearance of pulmonary secretions. 

The supportive care of the patient with pneumonia includes the use of humidified oxygen for hypoxemia, fluid resuscitation, administration of bronchodilators when bronchospasm is present, and chest physiotherapy with postural drainage if there is evidence of retained secretions. 

Mechanism of Action An intratracheal respiratory inhalant that splits the linkage of mucoproteins, reducingtheviscosityof pulmonary secretions.Tiierapeutic Effect Facilitates the removal of pulmonary secretions by coughing, postural drainage, mechanical means. Protects against acetaminophen overdose-induced hepatotoxicity. Pharmacokinetics Protein binding 83% (injection). Rapidly and extensively metabolized in liver. Deacetylated by the liver to cysteine and subsequently metabolized. Excreted in urine. Half-life 5.6 hr (injection). 

Decision/Solution. In addition to the neuromuscular facilitation activities, the physical therapist initiated a program of chest physical therapy including postural drainage and deep-breathing exercises. The physical therapist coordinated these activities with the respiratory therapist so that the patient first received a treatment of the mucolytic agent. Also, the physical therapist had the patient self-administer a dose of the inhaled beta-2 bronchodilator approximately 1 hour prior to the chest therapy session, thus allowing the bronchodilator to produce maximal airway dilation and permit optimal clearance of bronchial secretions. 

Q6 Comment on the reasons for including physical therapy, such as postural drainage, in treatment of this condition. 

The viscous mucus in cystic fibrosis is difficult to clear from the lung patients need physical therapy and postural drainage to clear the airways. 

On the efferent side of the cough reflex measures to render secretions more easily removable (muco-lytics, postural drainage) will reduce the amount of coughing needed, by increasing its efficiency. 

Provide pulmonary therapy by chest clapping and postural drainage as ordered. 

Oldenburg FA Jr, Dolovich MB, Montgomery JM, Newhouse MT. Effects of postural drainage, exercise, and cough on mucus clearance in chronic bronchitis. Am Rev Respir Dis 1979 120(4) 739-745. 

Percussion and postural drainage—Tapping on the thorax to physically loosen pulmonary secretions and posturing the body to facilitate expectoration. 

Although reduction in pulmonary infections is one of the reasons for PT in the ICU, a combined intervention of postural drainage and manual hyperinflation resulted in only a slightly lower incidence of nosocomial pneumonia among MV patients, compared with a control group who received standard nursing care (13% vs. 16%, respectively) (18). 

Hammon WE, Connors AF, McCaf ee DR. Cardiac arrhythmias during postural drainage and chest percussion of critically ill patients. Chest 1992 102 1836-1841. 

Figure 4 Manual chest physiotherapy applied in a postural drainage position in an airway disease patient.

Manual chest vibration used in conjunction with postural drainage in an airway disease... 

Pryor JA, Webber BA, Hodson BA, et al. Evaluation of the forced expiration technique as an adjunet to postural drainage in treatment of cystic fibrosis. BMJ 1979 2(6187) 417-418. American ThOTacic Society. Standards for the Diagnosis and Care of Patients with Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 1995 152(5 pt 2) S77-S121. Clarke SW, Pavia D. Lung mucus jnoduction and mucociliary clearance methods of assessment. Br J Clin Pharmacol 1980 9(6) 537-546. 

Ross J, Dean E, Abboud RT. The effect of postural drainage positioning on ventilation homogeneity in healthy subjects. Phys Ther 1992 72(ll) 794-799. 

Langenderfer B. Alternatives to percussion and postural drainage. A review of mucus clearance therapies percussion and postural drainage, autogenic drainage, positive expiratory pressure, flutter valve, intrapulmonary percussive ventilation, and high-frequency chest compression with the ThAIRapy Vest J Cardiopulm Rehabil 1998 18(4) 283-289. 

Oldenburg FA Jr., Dolovich MB, Montgomery JM, et al. Effects of postural drainage, exercise, and cough on mucus clearance in chronic bronchitis. Am Rev Respir Dis 1979 120(4) 739-745. Hess DR. The evidence Jot secretion clearance techniques. Respir Care 2001 46(11) 1276-1293. Wolmer P, Ursing K, Midgren B, et al. Inefficiency of chest percussion in the physical therapy of chronic bronchitis. Eur J Respir Dis 1985 66(4) 233-239. 

Lannefors L, Wollmer P. Mucus clearance with three chest physiotherapy regimes in cystic fibrosis a comparison between postural drainage, PEP and physical exercise. Eur Respir J 1992 5(6) 748-753. 

Varekojis SM, Douce EH, Flucke FH, et al. A comparison of the therapeutic effectiveness of and preference for postural drainage and percussion, intrapulmonary percussive ventilation, and... 

Oximetry feedback used to guide the use of MAC, postural drainage, and chest physical therapy to reverse desaturations below 95% due to airway mucus. 

Aspiration, atelectasis and pneumonia are common in potential donors, and therefore endotracheal suctioning, percussion, turning for postural drainage and occasional manual lung inflation are critically important. Mucopurulent secretions are frequent in donors with a normal chest radiograph and do not preclude lung donation. 

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