The Silent Threat of Wooden Chest Syndrome: Prompt Management of Fentanyl-Induced Muscle Rigidity in the Intensive Care Unit.

Introduction: Wooden chest syndrome (WCS) 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), WCS poses a significant challenge due to its rapid onset and potential to cause ventilatory failure if not addressed promptly. This case report examines WCS in a postoperative setting, emphasizing its recognition and management to improve patient outcomes. Case Presentation: A 49-year-old female with a history of cervical cancer, hypertension, and recent sigmoidectomy developed WCS 8 hours after starting a fentanyl infusion (50 μg/h, total ~400 μg) following an emergent incision and drainage for a 4 × 3 cm neck abscess. Initially stable on pressure-regulated volume control ventilation (peak airway pressure, Ppeak 20 cmH Conclusion: This case highlights WCS as a critical, reversible opioid-related complication in the ICU, necessitating vigilance during prolonged fentanyl use (>8 hours). Early detection via ventilator changes (e.g., Ppeak elevation) and swift intervention with naloxone and non-opioid sedation can prevent adverse outcomes. Increased awareness, staff training, and further research are vital to enhance ICU safety. LEARNING POINTS: