Study of postintubation airway stenosis (PIAS) following suicide attempts

The incidence of suicide attempts has been increasing in recent years. Presenting a group of patients who attempted suicide, underwent ventilatory support and got postintubation airway stenosis, may help us to better understand and prevent this complication. Among patients who referred to us for treatment of PIAS, those who were intubated for suicide attempts were investigated in a prospective study. Information were entered in a questionnaire and regular follow- ups were done in a 15 months period (Apr 2003 to Jul 2004). Among 100 patients with PIAS, 19 enrolled in the study. Mean age was 25.3 + 9.96 years (17-56 y), there were 10 females and 9 males. The type of disease and reason for suicide was categorized by a psychologist as psychosocial stress with an immature personality background in 11, psychological disorder in 7 and unknown cause in one. Direct causes for suicide were: family problems in 10, lovesick in 2, opium addiction in 3, depression in 6, social problems in 2 (in some patients, there were more than one cause). Mean time of intubation was 14.78 days (3-30 days), mean length of stenosis was 35.12 mm (20-50). Eight patients underwent a tracheostomy procedure. Three patients were treated with bronchoscopic dilation and 16 underwent laryngotracheal resection and reconstruction. There were 8 recurrences in the resected group of patients, of them, 4 were successfully re-resected, 2 recovered by bronchoscopic dilations and 2 managed by stents. This group of patients (study group) was compared with a similar group of patients in whom the causes of intubations were different (control group). The incidence of post-surgical recurrence (P=0.011) and the length of stenosis (P=0.01) were higher in the study group. In our patients, social problems like unemployment, illiteracy and singleness were more frequent cause of suicide than psychological disorders. Patients who underwent mechanical ventilation due to suicide and suffered PIAS could be treated by tracheal resection and reconstruction, although the incidence of post-surgical stenosis recurrence among them is more frequent than the other groups of patients.