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Publication Date
5-2021
Keywords
oregon; portland; ppmc; 2019-nCoV
Disciplines
Internal Medicine
Abstract
Case Presentation
History •47 yo M with no PMH presented with fever and respiratory distress •Admitted for COVID-19 pneumonia Hospital Course •Intubated for moderate acute respiratory distress syndrome (ARDS) on hospital day 11 •Fentanyl infusion started •Hypoxia improved within 36 hrsbut plateau pressures consistently >30 cm H2O despite minimizing dead space •Trial of airway pressure release ventilation worsened hypercarbia •Bronchoscopy w/o mucous plugging, airway collapse, or purulent secretions •Lung compliance worsened (Pplat=50 on 4 cc/kg) w/o change in oxygenation •Developed suspicion for wooden chest syndrome (WCS) and discontinued fentanyl Outcome •Pplatnadired at 16 within one hour after stopping fentanyl •Pt successfully extubated on VD 10
Takeaway Points
Fentanyl uniquely activates laryngeal and respiratory muscle potentially leading to a fatal syndrome known as Wooden Chest Syndrome (WCS) manifested by poor ventilation •It is likely more common than clinicians realize Implications in practice: •Maintain a high index of suspicion for alternate or overlying physiologies when treating persistent ventilatory failure in ARDS in COVID-19 Recommendation: •Discontinue fentanyl if lung compliance and ventilatory failure seem out of proportion to hypoxia
Specialty/Research Institute
Internal Medicine
Specialty/Research Institute
Graduate Medical Education
Conference / Event Name
Academic Achievement Day, 2021
Location
Providence Portland Medical Center
