Chest Physiotherapy and Cystic Fibrosis: Postural Drainage
Postural drainage (PD) is the use of specific body positions which utilize gravity-assisted mucociliary clearance. Postural drainage is accepted by many investigators as a necessary technique in treating CF patients with impaired mucociliary clearance.’ canada-neighbor.com
Further studies investigating the efficacy of PD and the FET, and FET alone or in the seated postion support these findings. Webber et al (1986) showed that in stable CF patients, PD and FET produced statistically significant improvements in pulmonary function tests (PFTs) over 3 days of treatment. Ver-boon et al (1986) also found that in CF patients who slept in a PD position (head down with a 20-degree tilt), FET alone was as effective as FET and PD during the first physiotherapy treatment of the day. PD alone and in combination with percussion, however, has been shown to increase the rate of respiratory isotope elimination, but not to the extent of directed coughing or CPT.
Percussion and vibration are manual techniques performed by an assistant, or independently by the patient, which aim to loosen and facilitate mucociliary clearance. Percussion can enhance speed, flow, and rate of sputum production without altering pulmonary function or oxygen saturation. Vibration can result in an immediate significant increase in arterial oxygen levels which persist for up to an hour post-treatment. Sutton et al (1985) and Murphy et al (1983) could show no additional benefit gained from the addition of percussion or vibration to treatments using PD and FET.
Decline in oxygen saturation during percussion also has been shown. McDonnell et al (1986) showed that multimodality CPT resulted in significant falls in oxygen saturation throughout treatment in a group of CF patients admitted to the hospital in exacerbation of their pulmonary disease. Oxygen saturation was continuously monitored in treatment sessions that consisted of PD, percussion, deep breathing, and coughing.