Fentanyl-Induced Rigid Chest Syndrome in Critically Ill Patients

Area of Science:

• Critical Care Medicine
• Anesthesiology
• Pharmacology

Background:

• Fentanyl-induced rigid chest syndrome (FIRCS) is a rare complication of opioid administration, typically seen during procedural sedation.
• FIRCS is characterized by thoracic and abdominal rigidity, leading to asynchronous ventilation and respiratory failure.
• This condition is infrequently reported in critically ill adult patients receiving continuous analgesia, suggesting it may be under-recognized.

Purpose of the Study:

• To describe the clinical presentation of FIRCS in intensive care unit (ICU) patients.
• To outline treatment strategies for FIRCS in the ICU setting.
• To highlight the potential under-recognition of FIRCS in critically ill populations.

Main Methods:

• Retrospective analysis of 42 ICU patients with suspected FIRCS.
• Documentation of clinical presentation, including thoracic and abdominal rigidity.
• Evaluation of treatment strategies, including naloxone and cisatracurium, and their impact on ventilator compliance.

Main Results:

• 52.4% of patients exhibited thoracic or abdominal rigidity.
• Naloxone administration resulted in improved ventilator compliance in 75% of patients.
• Naloxone was effective in resolving ventilator dyssynchrony attributed to fentanyl.

Conclusions:

• This is the largest case series on FIRCS in the ICU setting.
• Prompt recognition and management of FIRCS are essential for improving patient outcomes.
• Further research is needed to enhance awareness, identify risk factors, and evaluate interventions for FIRCS.