Is ETT administration of salbutamol liquid appropriate?

Question#: 675

Question:

I have seen endotracheal liquid bolus salbutamol several times in clinical settings with good effect, and have found a small but good study showing it to be very effective compared with mdi. What is RPPEOs opinion on ELB salbutamol? Say 5mg down the ETT instead of bagging in 800 ug with the BVM. It seems like it could be beneficial especially if have an intubated patient and limited hands in the back of the ambulance. I'm not advocating intubation to perform the procedure; but if my hand is forced by other factors it seems equally if not more effective, and superior from a work flow perspective.

Answer:

Endotracheal liquid bolus administration of salbutamol has been considered as an alternative to aerosolised salbutamol but there is limited literature on this method of administration of salbutamol; at this stage it is not a recommendation for routine practice. A small study does suggest that it may be a viable alternative to aerosolised salbutamol, however, the study is too small to support any change in current practice. Consideration to change practice is dependent on further studies with larger sample sizes and improved quality of evidence.

Aerosolised salbutamol can be delivered to ventilated patients via BVM, SGA, or ETT. While we typically use MDIs for administering salbutamol it is possible to set-up an in-line nebuliser using a simple T-piece and nebulizer cup if there is a need to free-up a hand from the MDI.

Thus, no, it is not appropriate to administer salbutamol liquid via the ETT.

References:

Albuterol (salbutamol): Drug information. Lexicomp. Accessed 20 Mar 2023
Fanta, C.H., & Cahill, K.N., 2022. Acute exacerbations of asthma in adults: Emergency department and inpatient management. UpToDate.
Golisano Children's Hospital. Nebulizer Treatments Using a Ventilator. Accessed 20 Mar 2023. https://www.urmc.rochester.edu/childrens-hospital/tracheostomy-ventilator-program/ventilator/nebulizer-treatments.aspx
Johnston, D.A., et al, 2015. A Comparison of Metered-Dose Inhaled Albuterol Versus Endotracheal Liquid Bolus Albuterol for the Treatment of Bronchoconstriction. https://rc.rcjournal.com/content/60/5/627?ijkey=6681f063dbc23f8f8a40a8ca560e5a63ead7654a&keytype2=tf_ipsecsha
Tobin, A., 2005. Intravenous salbutamol: too much of a good thing? https://pubmed.ncbi.nlm.nih.gov/16548805/