Date Published

May 19, 2023

Updated For

ALS PCS Version ALS PCS Version 5.2


What is the SWORBHP stance on administering salbutamol in patients with suspected ACPE? Most of us have been traditionally taught that salbutamol in patients presenting with crackles due to suspected ACPE is a negative thing because of the bronchodilation and the risk of flooding a patient. However, there are many studies that argue salbutamol administration could be beneficial. Especially in situations where patients are presenting with both wheezes and crackles, it can get confusing. Where does SWORBHP stand on this topic?


If you think that the patient has acute cardiogenic pulmonary edema, then you should withhold salbutamol. It is not the flooding of the patient that is the concern. Salbutamol works by treating bronchoconstriction. The pathology in ACPE is heart failure causing pulmonary edema and salbutamol will not treat this pathology. It can in fact cause worsening tachycardia and therefore potentially decrease cardiac function.

The wheeze in ACPE is due to fluid accumulation, not bronchoconstriction.



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