Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity
BackgroundChest wall rigidity is a known side effect of fentanyl use, which is why fentanyl is usually combined with a muscle relaxant such as mivacurium. Verifying endotracheal intubation is difficult in case of a rigid chest wall.Case presentationWe present the case of a preterm infant (29 complet...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-08-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.979763/full |
| _version_ | 1798037105068212224 |
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| author | Vincent D. Gaertner Tanja Restin Dirk Bassler Jean-Claude Fauchère Christoph M. Rüegger |
| author_facet | Vincent D. Gaertner Tanja Restin Dirk Bassler Jean-Claude Fauchère Christoph M. Rüegger |
| author_sort | Vincent D. Gaertner |
| collection | DOAJ |
| description | BackgroundChest wall rigidity is a known side effect of fentanyl use, which is why fentanyl is usually combined with a muscle relaxant such as mivacurium. Verifying endotracheal intubation is difficult in case of a rigid chest wall.Case presentationWe present the case of a preterm infant (29 completed weeks gestation, birth weight 1,150 g) with a prolonged chest wall rigidity after fentanyl administration for intubation despite adequate doses of mivacurium. This resulted in a pronounced desaturation without any effect on heart rate. Clinically, the infant showed no chest wall movement despite intubation and common tools to verify intubation (including end-tidal carbon dioxide measurement and auscultation) were inconclusive. However, using electrical impedance tomography (EIT), we were able to demonstrate minimal tidal volumes at lung level and thereby, EIT was able to accurately show correct placement of the endotracheal tube.ConclusionsThis case may increase vigilance for fentanyl-induced chest wall rigidity in the neonatal population even when simultaneously administering mivacurium. Higher airway pressures exceeding 30 mmHg and the use of μ-receptor antagonists such as naloxone should be considered to reverse opioid-induced chest wall rigidity. Most importantly, our data may imply a relevant clinical benefit of using EIT during neonatal intubation as it may accurately show correct endotracheal tube placement. |
| first_indexed | 2024-04-11T21:22:03Z |
| format | Article |
| id | doaj.art-3474f6c24ec84a778cdf3aa982d1001c |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-11T21:22:03Z |
| publishDate | 2022-08-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-3474f6c24ec84a778cdf3aa982d1001c2022-12-22T04:02:35ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-08-011010.3389/fped.2022.979763979763Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidityVincent D. GaertnerTanja RestinDirk BasslerJean-Claude FauchèreChristoph M. RüeggerBackgroundChest wall rigidity is a known side effect of fentanyl use, which is why fentanyl is usually combined with a muscle relaxant such as mivacurium. Verifying endotracheal intubation is difficult in case of a rigid chest wall.Case presentationWe present the case of a preterm infant (29 completed weeks gestation, birth weight 1,150 g) with a prolonged chest wall rigidity after fentanyl administration for intubation despite adequate doses of mivacurium. This resulted in a pronounced desaturation without any effect on heart rate. Clinically, the infant showed no chest wall movement despite intubation and common tools to verify intubation (including end-tidal carbon dioxide measurement and auscultation) were inconclusive. However, using electrical impedance tomography (EIT), we were able to demonstrate minimal tidal volumes at lung level and thereby, EIT was able to accurately show correct placement of the endotracheal tube.ConclusionsThis case may increase vigilance for fentanyl-induced chest wall rigidity in the neonatal population even when simultaneously administering mivacurium. Higher airway pressures exceeding 30 mmHg and the use of μ-receptor antagonists such as naloxone should be considered to reverse opioid-induced chest wall rigidity. Most importantly, our data may imply a relevant clinical benefit of using EIT during neonatal intubation as it may accurately show correct endotracheal tube placement.https://www.frontiersin.org/articles/10.3389/fped.2022.979763/fullchest wall rigidityelectrical impedance tomographypreterm infantwooden chest syndromeendotracheal intubationcase report |
| spellingShingle | Vincent D. Gaertner Tanja Restin Dirk Bassler Jean-Claude Fauchère Christoph M. Rüegger Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity Frontiers in Pediatrics chest wall rigidity electrical impedance tomography preterm infant wooden chest syndrome endotracheal intubation case report |
| title | Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity |
| title_full | Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity |
| title_fullStr | Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity |
| title_full_unstemmed | Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity |
| title_short | Case report: Intrapulmonary tidal volumes in a preterm infant with chest wall rigidity |
| title_sort | case report intrapulmonary tidal volumes in a preterm infant with chest wall rigidity |
| topic | chest wall rigidity electrical impedance tomography preterm infant wooden chest syndrome endotracheal intubation case report |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.979763/full |
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