Postural Drainage Therapy – Flashcards

is designed to improve mobilization of retained secretions, improve V/Q matching and normalize functional residual capacity (FRC). may include turning, postural drainage and percussion and vibration

- the rotation or movement of the body to promote lung expansion and improve arterial oxygenation - Also known as kinetic therapy or continuous lateral rotational therapy

- Inability or reluctance of patient to change positions - Hypoxemia associated with position of patient - Potential for or presence of atelectasis - Presence of artificial airway - Proning may be used in refactory hypoxemia associated with ards

Promote lung expansion Improve oxygenation Prevent retention of secretions Prevent venostasis (clot formation) Prevent skin ulcers (decubitus)

the drainage of secretions by the effect of gravity from small airways to large airways

Rhythmic striking of the thorax with a cupped hand or mechanical device to facilitate the loosening of retained secretions

Applications of rapid though fine tremorous movement during expiration to facilitate the movement of secretions

- Unstable spinal cord injuries - Traction of arm abductors - Severe diarrhea - Marked agitation - A rise in ICP - A large drop in BP; greater than 10 % - Worsening dyspnea, hypoxia and cardiac arrhythmias

- Ventilator disconnection - Accidental extubation - Accidental aspiration of ventilator circuit condensate - Disconnection of lines

Segmental bronchus is drained in a vertical position relative to gravity. Moves secretions from distal lung lobes or segments into the central airways, hopefully to be removed by coughing or suctioning. Positions held from 3 - 15 minutes. Depending on patient toleration. Greater success if there is adequate systemic and airway hydration

- Inability to mobilize retained secretions - Atelectasis caused by or suspected of being caused by mucus plugging - Presence of foreign body in airway

Stop the therapy, Stay with the patient, Stabilize

Breath sounds. Blood pressure. O2 saturation by pulse oximetry (if hypoxemia is suspected). Intracranial pressure

-Presumed effectiveness may be based on tradition and anecdotal reports rather than scientific evidence - Similar to IPPB this therapy has been excessively used in patients in whom it is not indicated - Airway clearance difficult in patient's with ineffective cough - Optimal positioning difficult in critically ill patients

- Intracranial pressure (ICP) > 20 mmHg - Head and neck injuring until stabilized (Absolute) - Active hemorrhage (Absolute) - Hemodynamic instability - Recent spinal surgery or acute spinal injury - Empyema - Bronchopleural fistula - Pulmonary edema associated with congestive heart failure (CHF) - Large pleural effusion - Pulmonary embolism - Aged, confused or uncooperative patients who do not tolerate positioning - Rib fractures with or without flail chest - Surgical wound or healing tissue

- Intracranial pressure (ICP) > 20 mmHg - Patients in whom increased ICP is to be avoided - neurosurgery, eye surgery - Uncontrolled hypertension - Distended abdomen - Esophageal surgery - Gross hemoptysis - Uncontrolled airway at risk for aspiration - tube feeding or recent meal

- Subcutaneous emphysema - Recent epidural spinal infusion or spinal anesthesia - Recent skin graphs on thorax - Burns, open wounds and skin infections of the thorax - Recently placed transvenous or subcutaneous pacemakers

- Increase in sputum production - Improvement in breath sounds - Restoration of normal vital signs - Resolution of abnormal chest x-ray - Normalization of ABG values or O2 saturation - Improvement in lung status for ventilator patient's - Improvement in lung status for ventilator patient's