Suicide attempts as the cause of post intubation airway stenosis [PIAS]

The incidence of suicide attempt has been increasing in recent years. Presenting a group of patients who attempted suicide, underwent ventilatory support and developed postintubation airway stenosis [PIAS] may help us in prevention and better understanding of this complication. Among patients who referred to our center for treatment of PIAS, those who had been intubated for suicide attempt were investigated in a prospective study. Information was entered in a questionnaire and regular follow ups were done in a 15-month period [April 2003 to July 2004]. Among 100 patients with PIAS, 19 enrolled in this study including10 females and 9 males [mean [ +/- SD] age, 25.3 [ +/- 9.96] yrs; ranging from 17 to 56 yrs]. Type of disease and reasons of suicide were categorized by a psychologist as follows: Eleven patients with psychosocial stress along with an immature personality back-ground, 7cases of psychological disorders and one with an unknown cause. Direct causes of committing suicide included family problems in 10 cases, lovesick in 2, addiction in 3, depression in 6 and social problems in 2 cases [some patients mentioned two reasons and one refused to mention the reason]. Mean time of intubation was 14.78 days [3-30 days], and the mean length of stenosis was 35.12 mm [20-50 mm], 8 patients underwent tracheostomy. Three patients were treated with bronchoscopic dilation and 16 underwent laryngotracheal resection and reconstruction. There were 8 cases of recurrence after resection among which 4 were treated by second resection, 2 recovered by bronchoscopic dilation and 2 managed by stenting. This group of patients [study group] was compared with a similar group of patients in whom the causes of intubations were different [control group]. Incidence of postsurgical recurrence [p=0.011] and the length of stenosis [p=0.01] were higher in the study group. In our patients, social problems such as unemployment, illiteracy and singleness were the more frequent causes of suicide compared with psychological disorders. Patients who undergo mechanical ventilation due to suicide and develop PIAS could be treated by tracheal resection and reconstruction; although the incidence of post- surgical recurrence is higher in them compared with the other groups of patients with PIAS