Wooden chest syndrome

One recent study hypothesized that chest wall rigidity might be at least partially responsible for some deaths related to intravenous injection of fentanyl, which increasingly is appearing in samples of heroin[2].

The primary cause of Wooden Chest Syndrome (WCS) is the administration of fentanyl, a synthetic opioid widely used in the medical field for its rapid onset of effects.

Additionally, non-pharmacological measures , such as manual ventilation and optimizing the patient’s body positioning, can be employed to improve breathing while waiting for pharmacological treatments to take effect.

Older adults face a greater risk of severe respiratory complications compared to younger individuals, due to reduced physiological resilience and preexisting health conditions.

One such case involved a 49-year-old male with chronic obstructive pulmonary disease (COPD) who developed WCS after being placed on pressure-control ventilation following the administration of a tracheostomy tube.

An 80-year-old male with chronic inflammatory demyelinating polyneuropathy (CIDP) and Guillain-Barré syndrome (GBS) was administered 50 μg of fentanyl before surgery for preoperative anxiolysis.

While comprehensive demographic data remains limited, current evidence suggests there are no significant correlations between geographic location or ethnic predispositions and the incidence of WCS.

However, due to the rare nature of WCS, its exact incidence remains difficult to track, and ongoing surveillance is necessary to better understand its trends, risk factors, and outcomes.

Studies are needed to determine the prevalence of WCS in medical and recreational settings, as well as to identify demographic, genetic, and patient-specific risk factors, such as underlying neuromuscular conditions or opioid receptor variations.

Investigating the mechanisms by which fentanyl induces thoracic rigidity, particularly its effects on mu-opioid receptors, the central nervous system, and brainstem respiratory centers, will help clarify the condition's pathophysiological basis.

Finally, addressing the public health implications of rising fentanyl use, especially in recreational settings, and studying long-term outcomes of WCS are key to reducing its overall impact.