Postural drainage (PD) is the drainage oflungsecretions usinggravity.^[1] It is used to treat a variety of conditions that cause the build-up of secretions in the lungs.

Postural drainage is used to treat any condition that causes the build-up of secretions inbronchopulmonary segments. These include:

• bronchiectasis^[2][3]
• lung abscesses^[2][3]
• cystic fibrosis^[3]
• atelectasis^[3]
• chronic obstructive pulmonary disease (COPD)^[3]
• pneumonia^[3]
• postoperative lung damage (after some thoracic surgery)^[3]
• COVID-19^[4]

Patients must receivephysiotherapy to learn to tip themselves into a position in which thelobe can be drained.

Postural drainage is often not suitable forinfants in theneonatal intensive care unit, who may have lots of equipment attached to them.^[5] Postural drainage is more difficult if patients experience poormobility,poor posture,pain,anxiety, andskin damage, usually requiring adaptations to the technique.^[6] Trendelenburg position which is head down position is relatively contraindicated in patients who have uncontrolled hypertension,orthopnea, recent grosshemoptysis, patients having intracranial pressure more than 20 mm Hg.^[7] Precautions should be taken with the patients who have rib fractures,osteoporosis,bronchospasm, and recent transplants.^[8]

Postural drainage is considered safe and effective, but may cause someside effects. The procedure is discontinued if the patient complains of headache,discomfort,dizziness,palpitations,^[3]fatigue, ordyspnea. Patients may be dyspneic after the various maneuvers, since the head-down position increases the work ofbreathing, reducestidal volume, and decreasesfunctional residual capacity (FRC).^{[citation needed]}

In postural drainage, the patient's body is positioned so that thetrachea is inclined downward and below the affectedchest area.^[9] The body is positioned so that secretions drain into sequentially largerbronchi.^[5]Frames,tilt tables, andpillows may be used to support patients in these positions.^[1][6] Up to 12 postures may be used.^[10] Patients may need time to adapt to certain postures.^[6]

Postural drainage is done at least three times daily for up to 60 minutes, with 30 minutes being common.^[3] It can be done in the night to reduce coughing at night (although PD should be avoided after meals), or in the morning to clearsecretions accumulated during the night.Bronchodilators can be used 15 minutes before PD is done to maximise its benefits.^[11] The most affected area is drained first to prevent infected secretions spilling into healthylung. Drainage time varies, but each position requires 10 minutes.^[12] If an entirehemithorax is involved, each lobe has to be drained individually, but a maximum of three position per session is considered sufficient.

Postural drainage is often used in conjunction with a technique for loosening secretions in the chest cavity such as chestpercussion.^[13] Chest percussion is performed by clapping the back or chest with a cupped hand. Bronchodilator medications may also be used before postural drainage to improve its effectiveness.^[6] Alternatively, amechanical vibrator may be used in some cases to facilitate loosening of secretions.^[13][14] There are drainage positions for all segments of the lung. These positions can be modified depending on the patient's condition.

Postural drainage may be followed bybreathing exercises to help expel loosened secretions from theairway, and coughingexercises to expel secretions.

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