Abstract Wooden chest syndrome is a rare, potentially fatal complication of high-dose fentanyl therapy, characterized by generalized muscle rigidity, reduced chest wall compliance, and acute respiratory distress. Frequently underdiagnosed in the intensive care unit (ICU). In this case report, we present a case of WCS in a patient with worsening respiratory distress in a 48-year-old female with history of asthma who presented for evaluation of shortness of breath, chills, myalgias, productive cough of yellow sputum. In ED Received albuterol, steroids and abx, placed on bipap and subsequently admitted to ICU. The patient was on continuous bipap for 16 hours without improvements on ABG, and the patient was subsequently intubated. The patient had difficult ventilation management. Started on bronchodilators, systemic steroids, azithromycin, lung protective ventilator strategy with permissive hypercapnia. Day 2; Patient became desynchronous with the vent. The patient started on a paralytic agent. The patient was also on ketamine, propofol and fentanyl infusions for sedation. Day 5; Bronchoscopy was done and showed a narrowed right mainstem bronchus with degree of bronchomalacia. Day 7; PEAK and Plateau pressures were high! Day 8; Fentanyl stopped and plateau pressure improved in 12-24 hours. Patient improved dramatically and she was extubated to nasal canula. What is Fentanyl rigid chest?It is a rare but serious medical emergency caused by fentanyl that results in extreme rigidity of the chest and abdominal muscles, severely impairing breathing. This syndrome is characterized by high-pressure ventilation, respiratory acidosis, and the sudden onset of respiratory failure. WCS remains an underrecognized complication of fentanyl therapy in the ICU, as illustrated by this case of a 48-year-old female who developed profound muscle rigidity and worsening respiratory failure after a few days from initiating a fentanyl infusion. Fentanyl is widely used for analgesia in ICU and we need to pay close attention to its complication. This rare entity, characterized by decreased chest wall compliance and acute ventilatory failure, poses a silent threat to critically ill patients. Our patient’s deterioration and lack of improvement after using all treatment modalities for asthma exacerbation by worsening Peak and Plateau pressures on PCV mode and respiratory acidosis; was quickly and nicely reversed through prompt discontinuation of fentanyl, successful extubation the very next day. The case highlights the need for heightened vigilance during opioid administration, especially with continuous infusions exceeding 8 hours. This abstract is funded by: None
Bdair et al. (Fri,) studied this question.