Postural Drainage Therapy (PDT) uses gravity to clear excess mucus from the lungs. This technique positions the body so that specific lung areas requiring clearance are elevated, allowing gravity to move fluid into the central airways where it can be coughed out. Because the lungs are complex and divided into many segments, the number of distinct positions required for comprehensive drainage can be challenging to memorize. This guide provides structured memory strategies to simplify the recall of these gravity-assisted positions.
Understanding Lung Segmentation and Gravity
The large number of required positions exists because the lungs are divided into distinct regions called bronchopulmonary segments. Each lung has lobes—three on the right and two on the left—which are further subdivided into multiple segments, each with its own draining airway, or bronchus. The goal of Postural Drainage is to place the specific segment that needs clearing in a position where its draining bronchus is oriented vertically downward.
Using gravity strategically ensures that the fluid moves from the smaller, peripheral airways into the central trachea. If a segment is not correctly positioned, the fluid may pool or move to an incorrect area, reducing the therapy’s effectiveness. Mastering the positions requires understanding the three-dimensional anatomy of the lungs and aligning the body to make the specific segment the highest point.
Visualizing Positions by Lobe Grouping
The most effective initial memory strategy is to group the positions based on the general lung lobe being treated, as this simplifies the overall body inclination required. Positions for the upper lobes, the highest part of the lung, typically require the body to be upright or only slightly reclined. These positions often involve sitting upright, sitting and leaning forward, or lying on the back with the head slightly elevated.
In contrast, draining the lower lobes, particularly the basal segments, necessitates a significant head-down tilt, known as the Trendelenburg position. This tilt, often between 30 and 45 degrees, ensures that gravity pulls the secretions upward from the base of the lung toward the main airways. The middle lobe and the lingula (the left lung’s equivalent) usually require a moderate, intermediate level of foot-end elevation, typically between 15 and 30 degrees.
Categorizing positions into three major groups—Upright (Upper Lobe), Moderate Tilt (Middle Lobe/Lingula), and Steep Tilt (Lower Lobes)—shifts the memory task to remembering three primary body angles. This grouping provides a foundational visual framework for organizing the more specific segment positions. Within these groups, positions are distinguished by lying on the back (supine), stomach (prone), or side (lateral), depending on whether the anterior, posterior, or side segment is being drained.
Core Mnemonics and Memory Tricks
To recall the specific positions within each lobe grouping, mnemonics and visual associations offer memory tools. For the upper lobe’s apical segments, which are drained by sitting upright, one can use the association “A for Apical, A for Airplane Seat,” envisioning a person sitting normally. For the posterior segment of the right upper lobe, which requires leaning forward, the mnemonic “P for Posterior, P for Prayer” helps, as the position resembles leaning over a pillow.
The lower lobe basal segments are often the most challenging to remember due to the necessary steep tilt and subtle turns. For instance, the anterior basal segments are drained when the person is supine (on their back) in the Trendelenburg position; the phrase “A is for Anterior, Asleep on your back” helps link the segment to the supine posture. Conversely, the posterior basal segments require the person to be prone (on their stomach) in the same steep tilt, which can be remembered as “P is for Posterior, Prone like a Pancake.”
The lateral basal segments, which require a side-lying position, can be recalled by associating “L is for Lateral, Lying on your Side,” while remembering that the affected side must be facing upward to drain. Using a Body Memory Palace, where one visually maps the positions onto a body lying on a bed, can provide a consistent structure for organizing segment-specific associations. Picturing objects or characters in the exact position on a mental image of a patient helps link the segment name directly to the required body posture.
Essential Safety and Timing Considerations
Proper execution requires attention to both timing and safety once the correct position is recalled. Each drainage position should be maintained for a minimum of five minutes, often up to 10 or 15 minutes, allowing sufficient time for gravity to mobilize the secretions. During this time, the patient is encouraged to breathe deeply and then perform a “huff” or controlled cough to move the loosened mucus out of the central airways.
The therapy should be scheduled strategically, ideally before meals or at least one and a half to two hours after eating, to minimize the risk of gastric reflux or vomiting. If a bronchodilator is part of the treatment plan, it should be inhaled about 15 minutes before starting the drainage to open the airways and maximize the therapy’s effectiveness.
Certain medical conditions make the head-down positions (Trendelenburg) unsafe. Individuals with uncontrolled hypertension, recent head trauma, severe acid reflux, or increased intracranial pressure must avoid the steep tilt positions. If any position causes difficulty breathing, dizziness, or headache, the therapy should be immediately adjusted or stopped.