Opioids can also be used in this situation for pain, but be aware of the potential side effect of chest wall rigidity. Rigidity is more often described with high doses of fentanyl and in pediatric patients, but cases have also been reported with standard fentanyl dosing and in adults . It can cause muscle rigidity affecting the chest wall, which interferes with mechanical ventilation. If you suspect this side effect in concurrence with decreased ventilator compliance (and lack of another cause like obstruction, tube dislodgement, etc.), stop the opioid and give naloxone. [9,13]
The work required to initiate and sustain gas flow from most modern microprocessor-based ventilators is negligible and can be adjusted through selection of trigger modes, either pressure or flow, and selection of breath types. However, even more critical is the imposed WOB created by artificial airways. Care is required in the selection of a properly sized artificial airway and also in maintaining its patency with appropriate bronchial hygiene procedure. Inadvertent narrowing of an endotracheal or tracheotomy tube, from accumulated secretions or compression, will result in a profound increase in patient work.
The American College of Chest Physicians is the global leader in advancing best patient outcomes through innovative chest medicine education, clinical research, and team-based care. With more than 19,000 members representing 100+ countries around the world, our mission is to champion the prevention, diagnosis, and treatment of chest diseases through education, communication, and research. This includes connecting health-care professionals to the latest clinical research and a wide array of evidence-based guidelines through the CHEST Journal, while also serving as a total education resource for clinicians through year-round meetings, books, mobile apps, and live courses in pulmonary, critical care, and sleep medicine. The first medical association with a clinical simulation program accredited by the Society for Simulation in Healthcare, the American College of Chest Physicians also provides hands-on training through innovative simulation education. The CHEST Foundation, our philanthropic arm, provides members with grants, patient education tools, and other resources to help their patients live and breathe easier.