Objective Characterization of Opiate-Induced Chest Wall Rigidity

• Published in: Curēus (Palo Alto, CA) Vol. 12; no. 6; p. e8459
• Main Authors: Trujillo, Charles, Rudd, David, Ogutcu, Hakan, Dong, Fanglong, Wong, David, Neeki, Michael
• Format: Journal Article
• Language: English
• Published: Palo Alto Cureus Inc 05.06.2020; Cureus
• Subjects: Abdomen; Airway management; Compliance; Drug dosages; Emergency Medicine; Fentanyl; General Surgery; Morphine; Narcotics; Patients; Variables; Ventilators
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.8459

IntroductionOpiate-induced chest wall rigidity is a syndrome that largely goes unrecognized. To date, no study has presented significant objective data to better understand this syndrome.ObjectiveThe aim of this study was to explore the correlation between the dosage of opiates and the incidence of chest wall rigidity, ventilatory changes, and effects of naloxone administration.MethodsA total of eight patients were identified as having episodes of chest wall rigidity, with half of the population being females, with an average age of 54.8 ± 9 years. Physiological changes, ventilator data, vitals, and opiate dosage prior to chest wall rigidity episodes and after reversal with naloxone administration were analyzed using the Wilcoxon rank sum test for statistical significance.ResultsSignificant changes were observed in dynamic wall compliance without positive end-expiratory pressure (PEEP) (pre-median=5.13; post-median=52.03; p=0.0078), dynamic wall compliance with PEEP (pre-median=6.13; post-median=72.36; p=0.0078), tidal volume (pre-median=110.5; post-median=1006; p=0.0078), and ventilator airflow (pre-median=0; post-median=75; p=0.0078). However, no statistically significant changes were detected in end tidal CO2 (pre-median=36; post-median=37.5; p=0.4219), respiratory rate (pre-median=9; post-median=10.5; p=0.7188), or peak airway pressure (pre-median=17; post-median=21.5; p=0.4063). Additionally, there is a statistically significant correlation between morphine equivalent potency dosing within 24 hours and the change in tidal volume (r=0.8237; p=0.0439).ConclusionsOur study is the first to demonstrate significant objective data on the ventilatory responses seen with opiate-induced chest wall rigidity. These findings may assist clinicians in better understanding the presentation and management of chest wall rigidity.