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Fentanyl-Induced Wooden Chest Syndrome Masquerading As Severe Respiratory Distress Syndrome In Covid-19, Grace Judd, Rachael Starcher, David Hotchkin
Fentanyl-Induced Wooden Chest Syndrome Masquerading As Severe Respiratory Distress Syndrome In Covid-19, Grace Judd, Rachael Starcher, David Hotchkin
Providence Portland Medical Center Internal Medicine 2021
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 …