title: A modified postural drainage position produces less cardiovascular stress than a head-down position in patients with severe heart disease: a quasi-experimental study.
abstract: OBJECTIVE
  Does a modified postural drainage position (horizontal) produce less cardiovascular and respiratory stress than a head-down postural drainage position (30 degrees) in people with severe heart disease?
  
  
  METHODS
  A quasi-experimental study.
  
  
  METHODS
  Thirty-one patients (mean age 69 years, SD 13) with severe left ventricular systolic dysfunction (mean ejection fraction 23%, SD 7) who were stable, receiving regular medication and free of acute respiratory illness.
  
  
  METHODS
  Two manoeuvres were performed--one from long sitting to a modified (horizontal) postural drainage position, and one from long sitting to a head-down (30 degrees) postural drainage position.
  
  
  METHODS
  Cardiovascular responses examined were blood pressure, sphygmocardiographic indices, and cardiac rhythm. Respiratory responses examined were respiratory rate, transcutaneous arterial oxyyhaemoglobin saturation, and dyspnoea.
  
  
  RESULTS
  Three participants were intolerant to the postural drainage positions--two during head-down and one during modified positioning. The remaining 28 participants maintained their resting cardiac rhythm and did not complain of chest pain or dyspnoea. The changes in cardiovascular responses during the sitting to head-down postural drainage manoeuvre in the tolerant participants were significantly greater (p < 0.05) than the changes during the sitting to the modified postural drainage manoeuvre for most of the sphygmocardiographic indices. In contrast, there were no significant respiratory responses to either postural drainage manoeuvre.
  
  
  CONCLUSIONS
  Modified positioning is associated with less cardiovascular stress than head-down positioning, yet for most patients with severe heart disease, both positions are generally well tolerated. For a subset of these patients, either position may be inappropriate. This suggests that modified positioning should be attempted first but that a head-down position may be attempted if the modified position proves ineffective.
authors.affiliation: Whitlam Joint Replacement Centre, Fairfield Hospital, Sydney, NSW, Australia. justine.naylor@sswahs.nsw.gov.au
authors.forename: Justine M
authors.initials: JM
authors.lastname: Naylor
authors.forename: Anthony
authors.initials: A
authors.lastname: McLean
authors.forename: Chin-Moi
authors.initials: CM
authors.lastname: Chow
authors.forename: Robert
authors.initials: R
authors.lastname: Heard
authors.forename: Iris
authors.initials: I
authors.lastname: Ting
authors.forename: Albert
authors.initials: A
authors.lastname: Avolio
mesh_terms: D000368:Aged; D002319:Cardiovascular System / Q000503:physiopathology; D015916:Drainage, Postural / Q000009:adverse effects / Q000379:methods*; D004417:Dyspnea / Q000209:etiology; D005260:Female; D018475:Head-Down Tilt / Q000009:adverse effects; D006331:Heart Diseases / Q000503:physiopathology* / Q000534:rehabilitation*; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D012137:Respiratory System / Q000503:physiopathology; D016896:Treatment Outcome