What does this research mean for the field?

Fentanyl administration can induce severe chest wall rigidity (Wooden Chest Syndrome) in mechanically ventilated patients, which can be effectively reversed by discontinuing the opioid and initiating a naloxone infusion. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To explore the occurrence and management of Wooden Chest Syndrome (WCS) from fentanyl use in an elderly patient.

May 20, 2026

C49-43 Wooden Chest Syndrome From Fentanyl

Key Points

To explore the occurrence and management of Wooden Chest Syndrome (WCS) from fentanyl use in an elderly patient.
Patient presentation with dyspnea and hypoxia after fentanyl administration.
Assessment of respiratory status using bronchoscopy and ultrasound.
Comparison of treatment outcomes with naloxone and cisatracurium.
Fentanyl infusion led to significant chest wall rigidity and respiratory distress.
Use of naloxone improved pulmonary compliance more effectively than cisatracurium.
Patient was successfully extubated after naloxone treatment on day 3.

Abstract

Abstract Introduction Hamilton and Cullen presented opioid-induced chest wall rigidity, also known as Wooden Chest Syndrome (WCS) in 1953. WCS is a rare complication of the use of synthetic opioids. Fentanyl's high lipophilicity allows it to pass the blood-brain barrier which could explain the reason fentanyl consistently promotes muscular rigidity more than other opioids. Description Our patient is an 83-year-old female, who presented with dyspnea and hypoxia, and was diagnosed with Influenza pneumonia. She was intubated in the ER and sedated with Propofol. One arrival to ICU, she was noted to be experiencing significant discomfort, so a push of 100 mcg fentanyl was given followed by a drip. This led to high peak pressure alarm on the ventilator along with low minute ventilation and respiratory rate along with absence of flow delivery with machine triggered breaths (see image). The patient had limited chest excursion and tense abdominal muscles, with worsening hypoxia and hypercapnia. Mucus plug, endotracheal tube malposition, pneumothorax and ventilator malfunction were ruled out in quick succession using bronchoscopy, point-of-care ultrasound and exchanging the ventilator. Attempts to increase sedation failed to resolve the desynchrony, however use of rocuronium gave temporary relief. Due to suspicion of WCS, fentanyl was eventually turned off, and naloxone drip was started. This gradually improved her respiratory status allowing for extubation on day 3. Discussion Physiological studies have shown that fentanyl can stimulate vagal C-fibers, linked to heightened muscular tone in the thoracic and upper airway, presenting as chest wall rigidity. Both high and low dose infusions have been implicated in WCS. It is important to note that laryngospasm and respiratory muscle rigidity can happen within two minutes of giving fentanyl and last up to 15 minutes. In a comparison analysis in patients with WCS, patients treated with naloxone showed more improvement in pulmonary compliance compared to cisatracurium. This abstract is funded by: None

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C49-43 Wooden Chest Syndrome From Fentanyl

Key Points

Abstract

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