Reference — Clinical Skills
Postural Drainage Positions
Which body position drains which lung segment, in one table — plus the head-down contraindications and timing that turn a textbook diagram into safe bedside practice.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Postural drainage uses gravity to drain secretions from specific bronchopulmonary segments; each segment has an optimal position. Steep head-down (Trendelenburg) positions are increasingly modified or avoided because of aspiration and intracranial-pressure concerns.
Position by Segment
| Lobe | Segment | Position |
|---|---|---|
| Upper lobes | Apical segments | Sitting upright, leaning slightly back |
| Upper lobes | Posterior segments | Sitting, leaning forward |
| Upper lobes | Anterior segments | Supine, flat |
| Right middle lobe | — | Head down about 15 degrees, lying on the left side, rotated a quarter-turn backward |
| Left lingula | — | Head down about 15 degrees, lying on the right side, rotated a quarter-turn backward |
| Lower lobes | Superior segments | Prone, flat (no tilt) |
| Lower lobes | Anterior basal | Head down about 30 degrees, supine |
| Lower lobes | Posterior basal | Head down about 30 degrees, prone |
| Lower lobes | Lateral basal | Head down about 30 degrees, lying on the opposite side |
Clinical Notes
- Head-down contraindications. Trendelenburg positions are contraindicated or used with caution in increased intracranial pressure, recent neuro or eye surgery, uncontrolled hypertension, active hemoptysis, aspiration/GERD risk, hemodynamic instability, and shortly after meals.
- Modified positions & timing. Many institutions now use modified (non-head-down) positions; hold each position about 3–15 minutes as tolerated.
- Combine techniques. Combine positioning with percussion/vibration and follow with a directed cough or huff.
Related Resources
Sources
- Strickland SL, Rubin BK, Drescher GS, et al. AARC Clinical Practice Guideline: Effectiveness of nonpharmacologic airway clearance therapies in hospitalized patients. Respir Care. 2013;58(12):2187-2193.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Airway clearance therapy.