Overview of Postural Drainage and Vibration
Chest physical therapy (CPT) is a treatment method that uses specific techniques to help clear mucus from the lungs. These techniques include chest percussion (tapping on the chest), postural drainage (using body positions to let gravity help drain mucus), and vibration (applying rhythmic pressure to help loosen mucus). This type of therapy is very important for managing conditions like cystic fibrosis, chronic obstructive pulmonary disease (COPD), and certain neuromuscular disorders. These conditions often produce excess mucus that the body struggles to clear out.
When the body can’t effectively clear out mucus, it’s easier for infections to take hold, leading to inflammation and lung damage. This can worsen a patient’s respiratory health and overall well-being. Because of this, regular and proper airway clearance is key in both managing these conditions and preventing serious complications.
There are many different sorts of airway clearance techniques, including different types of breathing exercises and various mechanical devices. Some specific methods include mechanical insufflation-exsufflation (a machine that alternates between positive and negative pressure to simulate a deep cough), high-frequency chest wall oscillation (a vest that vibrates the chest to help break up mucus), and manual chest physiotherapy (chest percussion and postural drainage performed by a physical therapist). Each of these approaches has its own ways of helping clear out mucus, improving lung function, and improving the patient’s overall health.
We’re constantly conducting research and developing new ways to maximize the effectiveness of these techniques. The goal is to continue improving respiratory care for the patients who need it.
Anatomy and Physiology of Postural Drainage and Vibration
Airway Clearance Therapies (ACTs) are designed to help with the natural process of cleaning out your lungs. The lungs and airways are lined with tiny hair-like structures, called cilia, and mucus-producing glands. These work together to protect your lungs. They trap dust particles or germs in a layer of mucus. Then, the cilia beat and move this mucus out of your lungs, a process called mucociliary clearance.
In conditions like cystic fibrosis and COPD, this natural cleaning system can be less effective. This is because these conditions change the amount or thickness of the mucus, making it harder for your lungs to clear out.
ACTs use different techniques to boost this lung cleaning process. Techniques like Manual Chest Physiotherapy (MCP), Positive Expiratory Pressure (PEP) devices, High Frequency Chest Wall Oscillation (HFCWO), and autogenic drainage. These can help move mucus towards wider airways, where it’s easier for you to cough it out.
However, how well these techniques work depends on factors like the size of your airways, if your airways are blocked, and if you can cough effectively. Every person’s lungs are unique, and what might work for one person may not work for another. Understanding your specific needs is crucial to picking the best ACT, which can help improve your lung function and overall health.
Why do People Need Postural Drainage and Vibration
Airway clearance therapies, or ACTs, are used when lung issues lead to a build-up of mucus, problems with airway clearance, and irregularities in air supply and blood flow to the different parts of the lung. These therapies are especially helpful in conditions that cause excessive mucus production, difficulty clearing secretions, or impaired lung function. Conditions that might require these therapies could include severe COPD (a lung disease that causes difficulty breathing), cystic fibrosis, bronchiectasis (another lung condition causing difficulty breathing), pneumonia, atelectasis (when the small parts of the lung collapse), neuromuscular disorders that impact respiratory function, and recovery from chest or belly surgeries.
There is a selection of techniques available to treat different respiratory disorders. These techniques can include postural drainage (a technique used to remove secretions), suctioning, and breathing exercises. The therapy chosen generally depends on the disease and the patient’s overall health.
Postural drainage techniques, whether done by hand or with a machine, that use vibration or mechanical methods, are typically advised for individuals with conditions that lead to significant mucus production, such as cystic fibrosis, bronchiectasis and some cases of COPD. These techniques may also be used when individuals are unable to effectively cough up mucus. This could possibly be the case for older adults, individuals with muscle weakness, or those recovering from surgery, injury, or serious critical illness.
Airway suctioning is another technique used to help remove secretions from the airways. Suctioning can also clear secretions when there is a tracheostomy (an opening in the windpipe) or an endotracheal tube (a tube inserted in the windpipe) used during ventilation (helping a patient breathe). This method of suctioning the endotracheal tube may be done using open or closed methods. However, the use of normal saline solution before suctioning is not suggested, as it may increase the risk of complications like low oxygen in the blood, slow heart rate, and stimulation of the vagus nerve (a nerve that controls heart rate, digestion and other body functions) or aspiration (inhaling food or drink into the lungs).
Respiratory exercises, on the other hand, can help cure atelectasis and clear thick secretions from the smaller to the larger airways, aiding in their release, especially when the cough is weak or when natural postural drainage is impaired. Breathing exercises are especially beneficial for individuals with COPD or recently removed from ventilation.
When a Person Should Avoid Postural Drainage and Vibration
Airway Clearance Techniques (ACTs) can help many people who have problems with their breathing, but they’re not safe or effective for everyone. Doctors have to think about a few key issues to make sure their patients are safe. For instance, these techniques may not be safe for someone if they have very unstable vital signs, are really struggling to breathe due to a condition known as ‘acute respiratory distress syndrome’, have an untreated collapsed lung (pneumothorax), recently had spine surgery, just injured their spinal cord, are coughing up blood (active hemoptysis), broke their rib, or have a condition that could make pressure in their head to become dangerously high.
One of these ACTs is called postural drainage, which requires patients to get into specific positions to help get rid of extra mucus in their lungs. But it’s not safe for everyone. People who can’t get into the required positions or who have recently coughed up blood, broken a rib or backbone, have extremely weak bones (severe osteoporosis), or have a high risk of bleeding, should not use this method.
Doctors also need to be careful with patients who have extremely weak bones, are currently dealing with an infection called tuberculosis, or have conditions like stroke that make them highly likely to inhale food, liquid, or vomit into their lungs (a condition called aspiration). The type of ACT chosen should be customized based on the patient’s health status and the potential risks of each method. Assessing each patient’s condition and any reasons why the techniques may not be safe for them is essential in choosing the right and safe way to help clear their airways.
Equipment used for Postural Drainage and Vibration
Airway suctioning is a process where a soft plastic tube is carefully placed through the nose and slides a little way into the windpipe. This method is used to help remove any mucus or other substances that the patient has trouble coughing up by themselves. The tube creates a sort of vacuum to gently remove these secretions. To ensure the patient doesn’t experience a shortage of oxygen (hypoxia) during this procedure, they are given 100% oxygen beforehand. This is crucial because for a short time during the method, the patient’s regular flow of oxygen is interrupted.
The tube is then softly placed down the nose and mouth. If the process hits a snag or encounters resistance, a short pause is made to ensure the patient can receive some oxygen. Afterward, the tube is positioned at the right depth before starting the suctioning. It’s crucial that this suctioning part of the process only lasts for about ten seconds. This short duration is recommended to avoid damaging the lining of the airway and to minimize the time the patient might be without enough oxygen.
How is Postural Drainage and Vibration performed
Several techniques can help to clear the respiratory system, often used to treat conditions such as cystic fibrosis, chronic obstructive pulmonary disease (COPD), bronchiectasis, and neuromuscular disorders. Here are a few key methods:
1. Manual Chest Physiotherapy (MCP)
This is a traditional technique where the chest wall is gently clapped or beaten either by cupped hands or a special device. This rhythmic motion helps to loosen and shift mucus (a thick liquid) that is stuck within the airways. The patient is also placed in different positions to help mucus drain from different parts of the lungs. These positions might involve lying facing up or down, on the side, or on the stomach. Deep breathing and coughing help to expel the loosened mucus and prevent blockages or a possible lung collapse.
2. Autogenic Drainage
This is a breathing technique that eliminates mucus from the airways. It involves three steps: unsticking, collecting, and evacuating. At first, slow and deep breathing helps loosen mucus from the inner walls of the airways. Next, slightly faster breathing helps move the mucus towards the larger airways. Lastly, deeper and more rapid breaths or coughs help expel the mucus from these larger airways.
3. Manual Assisted Coughing (MAC)
This technique helps those who have a compromised coughing function due to neuromuscular disorders, spinal cord injuries, and respiratory illnesses. A caregiver or healthcare professional applies external pressure to the chest and abdomen during a cough, which helps to produce a stronger cough and clear mucus from the airways more effectively.
4. Mechanical Insufflation-Exsufflation (MI-E)
This is a technique used when other methods are not effective in clearing mucus from the airways. It involves applying alternating positive and negative pressures to the airways to help move and clear mucus. MI-E is specially beneficial for those with conditions like amyotrophic lateral sclerosis (nerve cell disease), spinal cord injury, Duchenne muscular dystrophy (a genetic disorder causing muscle weakness), and spinal muscle atrophy (a disease that affects nerve cells controlling voluntary muscles).
In all of these techniques, the goal remains the same – to help clear the airways, prevent complications such as respiratory infections, and improve the overall respiratory health of individuals dealing with different respiratory disorders. The chosen method will depend on a patient’s specific needs and the judgment of the healthcare professional.
Possible Complications of Postural Drainage and Vibration
Airway Clearance Therapies (ACTs), which are treatments to help clear the lungs of mucus, are generally both safe and helpful. However, just like with any medication or procedure, doctors and nurses need to keep a close eye on a patient for potential problems. Treatment plans should be personalized to a person’s specific needs, and steps should be taken to minimize the chance that they’ll have an adverse reaction to the treatment.
There are a few complications associated with ACTs, such as breathing difficulties, injuries caused by sudden, blunt force (for example, a collapsed lung or air trapped around the lungs), muscle strains, unstable blood pressure, skin irritation or injuries, inhaling food or liquid into the lungs (aspiration), and mental stress. Using a Positive Expiratory Pressure (OPEP), a device to help clear the lungs, can cause problems such as coughing up blood, a collapsed lung, and sudden narrowing of the air passages in the lungs.
If a person has a heart condition that isn’t stable, has recently had chest or belly surgery, has a collapsed lung that hasn’t been treated, is in severe respiratory distress, is coughing up uncontrollable amounts of blood, has active tuberculosis, or has recent facial injuries or fractures, they might be more likely to have complications from ACTs. Their doctor shouldn’t start this kind of treatment until they have carefully checked the patient’s health history, current health status, and factors that could increase their risk of problems. This will ensure the therapy will be as safe as possible and provide the best health outcome.
What Else Should I Know About Postural Drainage and Vibration?
Airway clearance techniques (ACTs) are key in handling lung conditions that involve blockages or difficulty getting rid of mucus. These techniques make it easier to clear out mucus, secretions, and any foreign particles from your airways. This helps improve your breathing and how well your lungs exchange oxygen and carbon dioxide. ACTs work to stop lung problems from developing, like infections, atelectasis (collapse or closure of a lung), and pneumonia, while improving lung health and function over time.
These techniques keep your lungs in their best condition by clearing mucus and secretions, reducing inflammation in the airway, and lessening the chances of further lung damage in chronic lung diseases. Also, ACTs help in effectively delivering medication that you inhale, improving the results of the treatment and your overall lung health. All in all, ACTs play a significant role in all-round lung care by increasing lung function, reducing complications, and improving patient outcomes.
