The silent threat of wooden chest syndrome: prompt management of fentanyl-induced muscle rigidity in the intensive care unit

<i>Early detection is crucial:</i> wooden chest syndrome can manifest as sudden muscle rigidity and rising peak airway pressures within 8 hours of fentanyl infusion, requiring prompt recognition to prevent ventilatory failure.<i>Ventilator changes guide diagnosis:</i> elevated peak pressures with stable plateau pressures signal wooden chest syndrome, distinguishing it from lung pathology, and warrant immediate investigation.<i>Swift management improves outcomes:</i> stopping fentanyl, administering naloxone, and using dexmedetomidine can reverse wooden chest syndrome rapidly, enabling extubation within 48 hours.