Gravity Assisted Positioning

• Gravity Assisted Positioning:

  • The specific positioning of a patient utilising gravity in order to drain a particular bronchopulmonary segment
  • GAP is NOT used in isolation but as an adjunct to ACBT and may be used in conjunction with manual techniques
• Gravity Assisted Positioning:

  • The positions used for GAP are based on the anatomy of the bronchial tree
  • Places the bronchus of each bronchopulmonary segment perpendicular to gravity
  • What is a BPS? - specific region of a lung supplied by one bronchiole and vessels
  • This allows gravitational forces to assist the movement of bronchial secretions
• Commonly used GAP positions:

  • Supine lying – anterior segment both upper lobes
  • Side lying with head down tilt – lateral segment of lower lobes (uppermost lung)
  • 1/4 side lying with head down tilt – middle lobe / lingula (uppermost lung)
  • Upright sitting – apical segment of both upper lobes

  
• How long should treatment last?

  • Minimum of 10 minutes in each GAP position
  • Maximum of 2 positions per treatment session
  • Treatment should not really last longer than 30 minutes due to patient fatigue
• Precautions - Positions should be modified to accommodate:

  • the breathless, productive patient
  • cardiac failure
  • cardiovascular instability
  • neurological instability
  • unexplained haemoptysis
  • anyone with oesophageal reflux
  • oesophageal surgery