Postural drainage

Drainage used in bronchiectasis and lung abscess. The patient's body is positioned so that the trachea is inclined downward and below the affected chest area. Postural drainage is essential in treating bronchiectasis and patients must receive physiotherapy to learn to tip themselves into a position in which the lobe to be drained. It is done for at least three times daily for up to 30 minutes. It can be done on the night to reduce coughing at night (although PD should be avoided after meals) or in the morning to clear accumulated secretions during the night. Bronchodilators can be used 15 minutes before PD is done to maximise its benefits. The most affected area is drained first to prevent infected secretions spilling into healthy lung. Drainage time varies but each position requires 10 minutes. If an entire hemithorax is involved each lobe has to drained individual but a maximum of 3 position per session is consider sufficient. The procedure is discontinued if the patient complains of headache, discomfort, dizziness, palpitations, fatigue and dyspnea. Patients may be dyspnic after the various manuovers as the head down position increases work of breathing, reduces tidal volume and decreases FRC.