This document provides information on postural drainage positions and techniques for clearing secretions from the lungs. It describes the goals of preventing accumulation and removing secretions from different lung segments. Various positions are outlined to drain each lung segment, such as sitting forward or lying on the side. The techniques of percussion and vibration are explained to dislodge and mobilize mucus when combined with deep breathing and coughing. Contraindications to postural drainage are also listed.

1. Centre for Physiotherapy and Rehabilitation Sciences
Jamia Millia Islamia , New Delhi
Centre for Physiotherapy and Rehabilitation Sciences
Jamia Millia Islamia , New Delhi
Subject :402 Physiotherapy in cardiopulmonary conditions
Class : BPT IV year
Submitted to: Dr. Jamal Ali Moiz
Submitted by : Farah Tabassum
Date Of Presentation : 28th December 2020

2.  DEFINITION
• Postural drainage is an intervention for airway clearance by mobilizing
secretions in one or more lung segments to the central airways by placing
the patient in various positions so gravity assists in the drainage process.
• When secretions are moved from the smaller to the larger airways, then
they are cleared by coughing or endotracheal suctioning.
• Postural drainage therapy also includes the use of manual techniques such
as percussion, shaking, and vibration, and coughing.

3.  GOALS AND INDICATION
 Prevent accumulation of secretion in patient at risk for pulmonary complication:
a) Patients with pulmonary diseases that are associated with increased production or
viscosity of mucus, such as chronic bronchitis and cystic fibrosis.
b) Patients who are on prolonged bed rest.
c) Patients who have painful incision that restrict deep breathing and coughing
postoperatively.
d) Any patient who is on a ventilator.
 Remove accumulation secretions from the lungs:
a) Patients with acute or chronic lung diseases ,such as pneumonia , atelactasis , acute
lung infections , COPD.
b) Patients who are generally weak or are elderly.
c) Patients with artificial airways.

4.  CONTRAINDICATION
a) Intracranial pressure ICP> 20mm Hg
b) Head and neck injury until stabilized
c) Recent MI, unstable angina
d) Recent spinal surgery or acute spinal injury.
e) Severe hemoptysis
f) Severe hypertension or hypotension
g) Large pleural effusions
h) Rib fracture with or without flail chest
i) Pulmonary embolism

5. PERCUSSION VIBRATION
1. Percussion is used to augment mobilization of
secretions by mechanically dislodging viscous
or adherent mucus from the airways. Percussion
is performed with cupped hands over the lung
segment being drained.
2. The therapist’s cupped hands strike the patient’s
chest wall in an alternating, rhythmic manner
The therapist should try to keep shoulders,
elbows, and wrists loose and mobile during the
maneuver.
3. It is performed in both inspiratory and
expiratory breathing.
1. Vibration is performed with the aim of
moving secretion from periphery to the
central airways where they may be
suctioned .
2. The vibrating action is achieved by the
therapist isometrically contracting
(tensing) the muscles of the upper
extremities from shoulders to hands.
3. It is applied only during the expiratory
phase as the patient is deep-breathing.
MANUAL TECHNIQUE

6. The bronchopulmonary segment

7.  UPPER LOBE (APICAL SEGMENT)
• Patient sits in a comfortable position on the bed, on the flat drainage table and lean
on a pillow against the headboard of the bed . Caregiver percuss and vibrate over
the muscular area between the collarbone and the top of the shoulder blade on both
the left and right sides of the chest ,encourage the patient to take a deep breath and
cough during the percussion in order to clear the airways.

8.  UPPER LOBE ( POSTERIOR SEGMENT)
• The Patient sits comfortably on the chair or side of flat drainage table and leans
forward over a pillow at a 30 degree angle with arms swinging over a pillow.
Caregiver stand behind the patient then percuss and vibrate on the upper back on
the left and right sides of the chest.

9.  UPPER LOBE (ANTERIOR SEGMENT)
• The patients lies on his or her back on a flat drainage table with pillow under the
knees for comfort and one under the head. The caregiver percusses and vibrate
between the collarbone and nipple on both the left and right sides of the front of the
chest.

10.  LINGULA
• Elevate the foot of the table 14 inches (about 15 degrees). The patient lies with the
head downward the foot of the bed on the right side and rotates 1/4 turn backward.
A pillow may be placed behind the patient (from shoulder to hip) and their legs
slightly bent with another pillow between his or her knees. Percuss and vibrate just
outside the nipple area.

11.  MIDDLE LOBE
• Elevate the foot of the table 14 inches (about 35cm). The patient lies head down on
his left side and rotates 1/4 turn backward with right arm up and out of the way.
Legs and hip should be elevated as possible as. A pillow may be placed behind the
patient (from shoulder to hip) and slightly bent legs. Percuss and vibrate just
outside the right nipple area.

12.  LOWER LOBE (ANTERIOR BASAL SEGMENT)
• Elevate the foot of the table 18 inches (about 30 degrees). The patients lies on his or
her right side with the head facing the foot of the bed and a pillow behind the back.
The legs and hips should be elevated as high as possible on pillow. The knees
should be slightly bent and a pillow should be placed between them for comfort.
Percuss and vibrate over the lower ribs on the left side of the chest, as shown in the
diagram. To drain the right side of the chest, this repeated on the opposite side .
Percuss and vibrate over the lower ribs on the right side of the chest.

13.  LOWER LOBES (POSTERIOR BASAL SEGMENTS)
• Elevate the foot of the table 18 inches(about 30 degrees). The patients lies on his or
her abdomen, with a pillow under the hips and one pillow under the head. The
caregiver percuss and vibrate at the lower part of the back over the left and right
sides of the spine. Do not percuss or vibrate over the spine or lower ribs.

14.  LOWER LOBES ( LATERAL BASAL SEGMENTS)
• Elevate the foot of the table 18 inches (about 30 degrees).The patients lies on his or
her left side, and leans ¼ turn forward toward the table. The patient can flex his or
her upper leg over a pillow for support. Percuss and vibrate over the uppermost
portion of the lower ribs to drain the right side. To drain the left side, the patient lies
on his or her right side in the same position. Percuss and vibrate over the uppermost
portion of the lower left ribs.

15.  LOWER LOBES (SUPERIOR SEGEMENTS)
• The patients lies on his or her abdomen on a flat drainage table with two pillows
under the hips. Percuss and vibrate over the middle part of the back at the bottom of
the shoulder blade on both the left and right side of the spine. Do not percuss or
vibrate over the spine.

16. • REFERENCES
• https://www.cff.org/PDF-Archive/Introduction-to-Postural-Drainage-and-
Percussion
• Cash's Textbook of Chest, Heart and Vascular Disorders for
Physiotherapists - 4th Edition by Joan E. Cash, Patricia A. Downie, D. M.
Innocenti, S.E. Jackson