Autogenic drainage (AD)

Autogenic drainage is an airway clearance technique, it is a self drainage technique. it is used to clear the airway secretions

1. AUTOGENIC DRAINAGE t. Sunil kumar

2. introduction Autogenic drainage (AD) is a breathing technique that uses expiratory airflow to mobilize bronchial secretions. It is a self-drainage method that is performed independently by the patient in the sitting position.

3. AD consists of three phases: The " unsticking " phase. which loosens secretions in the peripheral airways, the " collecting " phase, which moves the secretions to the larger, more central airways , the " evacuating " phase, which results in the removal of the secretions.

4. This technique of airway clearance requires much patience and concentration to learn and is therefore not suitable for young children . It is ideal, however, for the adolescent or adult who prefers an independent method.

5. Equipment Required for AD No equipment is needed for a patient to perform the technique of AD. The patient must possess good proprioceptive, tactile, and auditory perception of the mucus moving; this feedback makes it possible to adjust the technique of AD. To teach this method to a patient, a caregiver requires keen tactile and auditory senses to coach a patient to move between the phases by listening to and feeling the location and the quality of the secretions.

6. Preparation for AD The patient should be seated upright in a chair with a back for support. The surroundings should be devoid of distractions, allowing the patient to concentrate on the breathing technique. The upper airways (nose and throat) should be cleared of secretions by huffing or blowing the nose.

7. The caregiver should be seated to the side and slightly behind the patient, close enough to hear the patient's breathing. One hand should be placed to feel the work of the abdominal muscles and the other hand placed on the upper chest

8. Treatment With Autogenic Drainage In all phases, inhalation should be done slowly, though the nose if possible, using the diaphragm or lower chest. A 2- to 3-second breath hold should follow, allowing collateral ventilation to get air behind the secretions. Exhalation should occur through the mouth with the glottis open, causing the secretions to be heard. The vibrations of the mucus may also be felt with the hand placed on the upper chest.

9. The frequency of these vibrations reveals their location. High frequencies mean that the secretions are located in the small airways; low frequencies mean that the secretions have moved to the large airways . The unsticking phase -This phase mobilizes mucus from the periphery of the lungs by lowering the mid-tidal volume below the functional residual capacity level. In practice, inspiration is followed by a deep expiration into the expiratory reserve volume. The patient attempts to exhale as far into the expiratory reserve volume as possible, contracting the abdominal muscles to achieve this.

10. This low lung volume breathing continues until the mucus is loosened and starts to move into the larger airways . The collecting phase : This phase collects the mucus in the middle airways by increasing the lung volume over the unsticking phase. Tidal volume breathing is then changed gradually from expiratory reserve volume toward the inspiratory reserve volume range so that the lungs are expanded more with each inspiration . The patient increases both inspiration and expiration to move a greater volume of air .

11. This low to middle lung volume breathing continues until the sound of the mucus decreases, signalling its movement into the central airways to be evacuated . The evacuating phase - In this phase, the patient increases inspiration into the inspiratory reserve volume range. This middle-to-high lung volume breathing continues until the secretions are in the trachea and are ready to be expectorated . The collected mucus can be evacuated by a stronger expiration or a high volume huff . Non productive coughing should be avoided, since it may result in collapse of airways .

12. Compression of the airways should be avoided. If wheezing is heard, the expiratory flow rate must be decreased. Beginners may have to use pursed lips to avoid air way compression. Instructing the patient to roll the tongue (if possible) may assist in controlling the expiratory flow rate . The duration of each phase of AD depends on the location of the secretions. The duration of a session depends on the amount and viscosity of the secretions. A patient who is experienced in autogenic drainage will clear secretions in a shorter amount of time than a beginner. An average treatment will be 30 to 45 minutes in length

13. Advantages and Disadvantages of AD After instruction in the technique of AD has been completed , it may be performed independently by patients over 12 years of age and requires no additional equipment . Since it does not require the use of postural drainage positions, it is appropriate for patients with gastroesophageal reflux . It is also recommended for use in patients with airway hyperreactivity .

14. To learn this technique, patients must demonstrate good self-discipline and possess the ability to concentrate. This method takes more practice than others. A patient must also be available for periodic reevaluation and refinement of the technique . AD is not the treatment of choice for a patient who is unmotivated or uncooperative , and the study of flow volume curves suggests that AD would not be appropriate for small children even if they are cooperative.

15. The period of hospitalization for an acute pulmonary exacerbation is a difficult time for a patient to learn AD. In fact, patients who are skilled in the technique choose a more passive (less energy-consuming) form of airway clearance at such a time until they return to their baseline pulmonary status.

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